Feasibility of Transapical Cardioscopic Surgery in a Pig Model

Abstract

The proposed transapical cardioscopic platform is feasible for major intra-cardiac procedures.

The susceptibility of the aortic root: porcine aortic rupture testing under cardiopulmonary bypass

“…The quantity of Collagen I, III and IV are all signi cantly reduced in human aneurysms compared to non-aneurysmal acute ruptured porcine samples. Reassuringly there is good reproducibility of quanti cation between porcine and human non-aneurysmal samples as shown in earlier studies (4)(5)(6)(7)(8)(9)(10)(11)(12)(13) Limitations in this study includes histological analysis, whereby immunohistochemistry techniques are limited by the ability of the tissue to take up by the antibodies in question which result in more di cult specimens to analyse and quantify. In addition, pathological analysis and quanti cation are limited by the investigator and varies considerably with each analysis.…”

“…Using a physiological model, results could identify patterns in radiological, pathological, and histological changes that affect the aorta under stress. Although no studies apart from Surman et al (1) have reported on the maximal pressures obtained in the porcine aortic root and ascending aorta, many studies have showed that a porcine model is effective in the application of cardiopulmonary bypass and replicating models applicable to human subjects in cardiothoracic surgery (4)(5)(6)(7)(8)(9)(10)(11)(12)(13).…”

The Susceptibility of the Aortic Root: Porcine Aortic Rupture Testing Under Cardiopulmonary Bypass

“…The quantity of Collagen I, III and IV are all significantly reduced in human aneurysms compared to non-aneurysmal acute ruptured porcine samples. Reassuringly there is good reproducibility of quantification between porcine and human nonaneurysmal samples as shown in earlier studies [4][5][6][7][8][9][10][11][12][13].…”

“…Using a physiological model, results could identify patterns in radiological, pathological, and histological changes that affect the aorta under stress. Although no studies apart from Surman et al [1] have reported on the maximal pressures obtained in the porcine aortic root and ascending aorta, many studies have showed that a porcine model is effective in the application of cardiopulmonary bypass and replicating models applicable to human subjects in cardiothoracic surgery [4][5][6][7][8][9][10][11][12][13].…”

“…The most straightforward procedure required careful dissection of the pulmonary ligament, pulmonary veins, pulmonary artery, and finally bronchus Eckhouse et al [6] To establish a reproducible model of aortic dilatation reproducing what happens in Thoracic abdominal aneurysm's (TAA) development Descending TAA's were induced in 7 pigs using collagenase and crystalline and tissue analysed Tissue demonstrates aortic dilatation, aortic medial degeneration, and alterations in MMP/TIMP abundance consistent with TAA formation Kofidis et al [7] To determine the feasibility of transapical cardioscopic surgery in a pig model Transapical access to the ventricle was obtained in 5 pigs with right mini thoracotomy for central cannulation and CPB Transapical approach allowed for good exposure and adequate surgical field for mitral valve, and aortic valve access, and atrial ablation and intra-aortic procedures Lundemeon et al [8] To determine the effects of pulsed and non-pulsed CPB on microvascular fluid exchange A total of 16 pigs were randomized to pulsatile (n = 8) or non-pulsatile (n = 8) CPB No significant differences in the fluid extravasation rates were present between pulsed and non-pulsed cardiopulmonary bypass perfusion Mariscal et al [9] To describe a surgical technique for swine lung transplantation and postoperative management 3 days postoperatively Involved development of a protocol based on donor surgery, recipient surgery and postoperative care and sacrifice…”