Robotically assisted perventricular closure of perimembranous ventricular septal defects: Preliminary results in Yucatan pigs

Zahid Amin, Russell Woo, David A. Danford, Stacey E. Froemming, Vadiyala M. Reddy, John Lof, David Overman

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Objective: Robotic systems allow surgeons to perform minimally invasive cardiac surgery in adults. Experience in the pediatric population, however, is limited. Perventricular closure of muscular ventricular septal defects has been reported in humans but requires a median sternotomy. The objective of this study was to assess the feasibility of robotically assisted closure of perimembranous ventricular septal defects by using the perventricular approach. Methods: The procedure was attempted in 7 pigs with naturally occurring perimembranous ventricular septal defects. Echocardiography was performed to confirm the presence and assess the size of the defect. A 3-armed da Vinci system consisting of two 8-mm instrument ports and a 12-mm endoscopy port was used. A pericardiotomy was performed, and the right ventricular free wall was visualized. A spinal needle was advanced into the right ventricular cavity. By using echocardiographic guidance, a glide wire was advanced through the angiocatheter and manipulated through the defect into the left ventricle or the ascending aorta. A delivery sheath was advanced over the wire. An appropriately sized Amplatzer device was deployed through the sheath. Results: The procedure was successful in 5 pigs. One device was removed because it was smaller than the defect and an appropriately sized device was not available. The placement failed in the second pig in the series. Four pigs were followed up for 1 to 4 months. Angiograms performed before the pigs were killed documented complete occlusion in 3 and mild-to-moderate shunt in 1. Conclusions: Robotically assisted perventricular closure with the Amplatzer Membranous VSD Occluder is feasible. This approach avoids the associated morbidities of cardiopulmonary bypass and median sternotomy. Further investigation and refinements are needed, however, before application of this approach in humans.

Original languageEnglish (US)
Pages (from-to)427-432
Number of pages6
JournalJournal of Thoracic and Cardiovascular Surgery
Volume131
Issue number2
DOIs
StatePublished - Feb 1 2006

Fingerprint

Ventricular Heart Septal Defects
Swine
Sternotomy
Equipment and Supplies
Pericardiectomy
Minimally Invasive Surgical Procedures
Robotics
Cardiopulmonary Bypass
Endoscopy
Thoracic Surgery
Heart Ventricles
Needles
Echocardiography
Aorta
Angiography
Pediatrics
Morbidity
Population

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Robotically assisted perventricular closure of perimembranous ventricular septal defects : Preliminary results in Yucatan pigs. / Amin, Zahid; Woo, Russell; Danford, David A.; Froemming, Stacey E.; Reddy, Vadiyala M.; Lof, John; Overman, David.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 131, No. 2, 01.02.2006, p. 427-432.

Research output: Contribution to journalArticle

Amin, Zahid ; Woo, Russell ; Danford, David A. ; Froemming, Stacey E. ; Reddy, Vadiyala M. ; Lof, John ; Overman, David. / Robotically assisted perventricular closure of perimembranous ventricular septal defects : Preliminary results in Yucatan pigs. In: Journal of Thoracic and Cardiovascular Surgery. 2006 ; Vol. 131, No. 2. pp. 427-432.
@article{945523af16324becb788b18ce7050421,
title = "Robotically assisted perventricular closure of perimembranous ventricular septal defects: Preliminary results in Yucatan pigs",
abstract = "Objective: Robotic systems allow surgeons to perform minimally invasive cardiac surgery in adults. Experience in the pediatric population, however, is limited. Perventricular closure of muscular ventricular septal defects has been reported in humans but requires a median sternotomy. The objective of this study was to assess the feasibility of robotically assisted closure of perimembranous ventricular septal defects by using the perventricular approach. Methods: The procedure was attempted in 7 pigs with naturally occurring perimembranous ventricular septal defects. Echocardiography was performed to confirm the presence and assess the size of the defect. A 3-armed da Vinci system consisting of two 8-mm instrument ports and a 12-mm endoscopy port was used. A pericardiotomy was performed, and the right ventricular free wall was visualized. A spinal needle was advanced into the right ventricular cavity. By using echocardiographic guidance, a glide wire was advanced through the angiocatheter and manipulated through the defect into the left ventricle or the ascending aorta. A delivery sheath was advanced over the wire. An appropriately sized Amplatzer device was deployed through the sheath. Results: The procedure was successful in 5 pigs. One device was removed because it was smaller than the defect and an appropriately sized device was not available. The placement failed in the second pig in the series. Four pigs were followed up for 1 to 4 months. Angiograms performed before the pigs were killed documented complete occlusion in 3 and mild-to-moderate shunt in 1. Conclusions: Robotically assisted perventricular closure with the Amplatzer Membranous VSD Occluder is feasible. This approach avoids the associated morbidities of cardiopulmonary bypass and median sternotomy. Further investigation and refinements are needed, however, before application of this approach in humans.",
author = "Zahid Amin and Russell Woo and Danford, {David A.} and Froemming, {Stacey E.} and Reddy, {Vadiyala M.} and John Lof and David Overman",
year = "2006",
month = "2",
day = "1",
doi = "10.1016/j.jtcvs.2005.10.034",
language = "English (US)",
volume = "131",
pages = "427--432",
journal = "Journal of Thoracic and Cardiovascular Surgery",
issn = "0022-5223",
publisher = "Mosby Inc.",
number = "2",

}

TY - JOUR

T1 - Robotically assisted perventricular closure of perimembranous ventricular septal defects

T2 - Preliminary results in Yucatan pigs

AU - Amin, Zahid

AU - Woo, Russell

AU - Danford, David A.

AU - Froemming, Stacey E.

AU - Reddy, Vadiyala M.

AU - Lof, John

AU - Overman, David

PY - 2006/2/1

Y1 - 2006/2/1

N2 - Objective: Robotic systems allow surgeons to perform minimally invasive cardiac surgery in adults. Experience in the pediatric population, however, is limited. Perventricular closure of muscular ventricular septal defects has been reported in humans but requires a median sternotomy. The objective of this study was to assess the feasibility of robotically assisted closure of perimembranous ventricular septal defects by using the perventricular approach. Methods: The procedure was attempted in 7 pigs with naturally occurring perimembranous ventricular septal defects. Echocardiography was performed to confirm the presence and assess the size of the defect. A 3-armed da Vinci system consisting of two 8-mm instrument ports and a 12-mm endoscopy port was used. A pericardiotomy was performed, and the right ventricular free wall was visualized. A spinal needle was advanced into the right ventricular cavity. By using echocardiographic guidance, a glide wire was advanced through the angiocatheter and manipulated through the defect into the left ventricle or the ascending aorta. A delivery sheath was advanced over the wire. An appropriately sized Amplatzer device was deployed through the sheath. Results: The procedure was successful in 5 pigs. One device was removed because it was smaller than the defect and an appropriately sized device was not available. The placement failed in the second pig in the series. Four pigs were followed up for 1 to 4 months. Angiograms performed before the pigs were killed documented complete occlusion in 3 and mild-to-moderate shunt in 1. Conclusions: Robotically assisted perventricular closure with the Amplatzer Membranous VSD Occluder is feasible. This approach avoids the associated morbidities of cardiopulmonary bypass and median sternotomy. Further investigation and refinements are needed, however, before application of this approach in humans.

AB - Objective: Robotic systems allow surgeons to perform minimally invasive cardiac surgery in adults. Experience in the pediatric population, however, is limited. Perventricular closure of muscular ventricular septal defects has been reported in humans but requires a median sternotomy. The objective of this study was to assess the feasibility of robotically assisted closure of perimembranous ventricular septal defects by using the perventricular approach. Methods: The procedure was attempted in 7 pigs with naturally occurring perimembranous ventricular septal defects. Echocardiography was performed to confirm the presence and assess the size of the defect. A 3-armed da Vinci system consisting of two 8-mm instrument ports and a 12-mm endoscopy port was used. A pericardiotomy was performed, and the right ventricular free wall was visualized. A spinal needle was advanced into the right ventricular cavity. By using echocardiographic guidance, a glide wire was advanced through the angiocatheter and manipulated through the defect into the left ventricle or the ascending aorta. A delivery sheath was advanced over the wire. An appropriately sized Amplatzer device was deployed through the sheath. Results: The procedure was successful in 5 pigs. One device was removed because it was smaller than the defect and an appropriately sized device was not available. The placement failed in the second pig in the series. Four pigs were followed up for 1 to 4 months. Angiograms performed before the pigs were killed documented complete occlusion in 3 and mild-to-moderate shunt in 1. Conclusions: Robotically assisted perventricular closure with the Amplatzer Membranous VSD Occluder is feasible. This approach avoids the associated morbidities of cardiopulmonary bypass and median sternotomy. Further investigation and refinements are needed, however, before application of this approach in humans.

UR - http://www.scopus.com/inward/record.url?scp=31044440764&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=31044440764&partnerID=8YFLogxK

U2 - 10.1016/j.jtcvs.2005.10.034

DO - 10.1016/j.jtcvs.2005.10.034

M3 - Article

C2 - 16434274

AN - SCOPUS:31044440764

VL - 131

SP - 427

EP - 432

JO - Journal of Thoracic and Cardiovascular Surgery

JF - Journal of Thoracic and Cardiovascular Surgery

SN - 0022-5223

IS - 2

ER -