Direct Percutaneous Left Ventricular Access and Port Closure Pre-Clinical Feasibility

被引：13

作者：

Barbash, Israel M. ^{[1
]}

Saikus, Christina E. ^{[1
]}

Faranesh, Anthony Z. ^{[1
]}

Ratnayaka, Kanishka ^{[1
,3
]}

Kocaturk, Ozgur ^{[1
]}

Chen, Marcus Y. ^{[1
]}

Bell, Jamie A. ^{[1
]}

Virmani, Renu ^{[2
]}

Schenke, William H. ^{[1
]}

Hansen, Michael S. ^{[1
]}

Slack, Michael C. ^{[3
]}

Lederman, Robert J. ^{[1
]}

机构：

[1] NHLBI, Cardiovasc & Pulm Branch, Div Intramural Res, NIH, Bethesda, MD 20892 USA

[2] CVPath, Gaithersburg, MD USA

[3] Childrens Natl Med Ctr, Washington, DC 20010 USA

来源：

JACC-CARDIOVASCULAR INTERVENTIONS | 2011年 / 4卷 / 12期

关键词：

hybrid surgical procedures; interventional magnetic resonance imaging; periventricular; transcatheter aortic valve replacement; AORTIC-VALVE IMPLANTATION; SEPTAL-DEFECT OCCLUDER; CARDIAC-SURGERY; LEFT-HEART; PUNCTURE; SWINE; CATHETERIZATION; COMPLICATIONS; REPLACEMENT; GUIDANCE;

D O I：

10.1016/j.jcin.2011.07.017

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objectives This study sought to evaluate feasibility of nonsurgical, transthoracic catheter-based left ventricular (LV) access and closure. Background Implanting large devices, such as mitral or aortic valve prostheses, into the heart requires surgical exposure and repair. Reliable percutaneous direct transthoracic LV access and closure would allow new nonsurgical therapeutic procedures. Methods Percutaneous direct LV access was performed in 19 swine using real-time magnetic resonance imaging (MRI) and an "active" MRI needle antenna to deliver an 18-F introducer sheath. The LV access ports were closed percutaneously using a commercial ventricular septal defect occluder and an "active" MRI delivery cable for enhanced visibility. We used "permissive pericardial tamponade" (temporary fluid instillation to separate the 2 pericardial layers) to avoid pericardial entrapment by the epicardial disk. Techniques were developed in 8 animals, and 11 more were followed up to 3 months by MRI and histopathology. Results Imaging guidance allowed 18-F sheath access and closure with appropriate positioning of the occluder inside the transmyocardial tunnel. Of the survival cohort, immediate hemostasis was achieved in 8 of 11 patients. Failure modes included pericardial entrapment by the epicardial occluder disk (n = 2) and a true-apex entry site that prevented hemostatic apposition of the endocardial disk (n = 1). Reactive pericardial effusion (192 +/- 118 ml) accumulated 5 +/- 1 days after the procedure, requiring 1-time drainage. At 3 months, LV function was preserved, and the device was endothelialized. Conclusions Direct percutaneous LV access and closure is feasible using real-time MRI. A commercial occluder achieved hemostasis without evident deleterious effects on the LV. Having established the concept, further clinical development of this approach appears realistic. (J Am Coll Cardiol Intv 2011;4:1318-25) (C) 2011 by the American College of Cardiology Foundation

引用

页码：1318 / 1325

页数：8

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