A novel cardioport for beating-heart, image-guided intracardiac surgery

Abstract

Objective Intracardiac beating-heart procedures require the introduction and exchange of complex instruments and devices. In order to prevent potential complications such as air embolism and bleeding, a universal cardioport was designed and tested. Methods The design consists of port body and a series of interchangeable sleeves. The port uses a fluid purging system to remove air from the instrument prior to insertion into the heart, and a valve system minimizes blood loss during instrument changes. Results The cardioport was tested ex vivo and in vivo in pigs (n=5). Beating-heart procedures such as septal defect closure and mitral valve repair were modeled. Ex vivo trials (n=150) were performed, and no air emboli were introduced using the port. In comparison, air emboli were detected in 40–85% of the cases without use of the port based purging system. Port operation revealed excellent ergonomics, and minimal blood loss. Conclusions A novel cardioport system designed to prevent air entry and blood loss from transcardiac instrument introduction was shown to be an enabling platform for intracardiac beating-heart surgery. The port system improves safety and facilitates further development of complex instruments and devices for transcardiac beating-heart surgery.

Percutaneous Steerable Robotic Tool Delivery Platform and Metal Microelectromechanical Systems Device for Tissue Manipulation and Approximation

“…After initial assessment of the anatomy by epicardial echocardiography using the X7-2 matrix transducer on an IE33 system (Philips Healthcare, Andover, MA), heparin was administered at 150 U/kg intravenously, and a tunnel-like PFO was created under video-assisted cardioscopy and epicardial echocardiography guidance. A cardioport system, previously described in [13] was used for cardioscopy. Briefly, the cardioport has two compartments: one, for imaging, and one, for instrument insertion and exchange.…”

Creation of Nonischemic Functional Mitral Regurgitation by Annular Dilatation and Nonplanar Modification in a Chronic In Vivo Swine Model

“…The cardioport is comprised of a plastic shaft with 2 channels, one for a 5-mm rigid 30° endoscope and the other for a cutting rod, and the head of the cardioport is covered by a transparent cap filled with saline solution to examine the intra-cardiac structures using a video-assisted imaging system (Figure 1A,B). 15,16,18 Fourteen to twenty-six 2mm annular incisions were made along the atrial aspect of the posterior mitral annulus between the fibrous trigones by pivot-turning the cardioport around the annulus from the purse-string (Figure 1C) under endoscopic guidance through the cardioport (Figure 1D). When the cardioport head was apart from the mitral annulus, the annulus was not visible because of the surrounding blood (Figure 1E-a); however, when the cardioport head was pushed against the annulus, the surrounding blood was displaced and the annulus was stabilized and visible through the endoscope (Figure 1E-b).…”

“…The cardioport was designed for two purposes: (1) to visualize structures inside the beating heart by housing an endoscope, and (2) to provide a working channel for instrument access inside the beating heart. 15,16 The cardioport is an all-in-one system that can easily be introduced into the heart, in contrast to some other existing cardioscopy concepts. 17 Using our cardioport system, we have successfully developed a swine model of functional tricuspid regurgitation by making tricuspid annular incisions to induce annular dilatation.…”

Cardioscopic Tool-Delivery Instrument for Beating-Heart Surgery

“…Tool-tissue interaction is then visualized through the optical window. Furthermore, the working channel and flushing port must be self-sealing to avoid the accidental injection of air into the heart or loss of blood out of the heart [17]. …”