Abstract 2762: Beating-Heart Patch Closure of Muscular Ventricular Septal Defects under Real-Time 3D Echo Guidance: Pre-Clinical Study
Background: The application of percutaneous and transcardiac device closure of ventricular septal defects (VSD) without cardiopulmonary bypass (CPB) has been challenging. We have developed a patch system that can be delivered and fixed by original Nitinol anchors under real-time 3D echo (RT3DE) guidance. We previously utilized this approach for closure of atrial septal defects of various geometry and size. We evaluated the efficacy of this system in closure of muscular VSDs.
Methods: In Yorkshire pigs (n=6) through a purse-string suture placed on the apical portion of the left ventricle (LV), a 10 mm coring device was introduced and advanced through the septum creating a muscular VSD The second purse-string was placed on the LV apex; the patch deployment device was advanced toward the VSD. The fixation device was then introduced through the first purse string, and the anchors were deployed one by one. After VSD closure, the residual shunt was assessed by 2D and 3D Color Doppler. Finally, the heart was excised and the efficacy of closure and patch fixation was confirmed.
Results: VSDs (9.7±1.7 mm, 8.2 – 12.0 mm) were created in midventricular (n=3), anterior (n=1) and apical (n=2) parts of the muscular septum. VSDs were completely closed in 5 animals. In 1 animal a residual shunt of 2.4 mm was present. No anatomical structures were compromised in any of the cases.
Conclusions: Beating-heart perventricular muscular VSD closure without CPB can be successfully achieved using the catheter-based patch delivery system combined with the anchor delivery device under RT3DE guidance. This approach may be a better alternative to open-heart surgery or transcatheter closure because a device is not used.