Patch Closure of Muscular Ventricular Septal Defects With a New Hybrid Therapy in a Pig Model
Rainer Kozlik-Feldmann, MD*,*,
Nora Lang, MD*,
Regine Aumann, MD*,
Anja Lehner, MS*,
Darius Rassoulian, MD ,
Ralf Sodian, MD, PhD,
Christoph Schmitz, MD, PhD,
Martin Hinterseer, MD ,
Rabea Hinkel, MD, PhD,
Eckart Thein, MD ,
Franz Freudenthal, MD||,
Nikolay V. Vasylev, MD¶,
Pedro J. del Nido, MD¶ and
Heinrich Netz, MD, PhD*
* Department of Pediatric Cardiology, University Hospital Grosshadern, Munich, Germany
Department of Cardiac Surgery, University Hospital Grosshadern, Munich, Germany
Department of Cardiology, University Hospital Grosshadern, Munich, Germany
Institute of Surgical Research, Ludwig-Maximilians-University, Munich, Germany
|| Department of Pediatric Cardiology, Kardiozentrum, La Paz, Bolivia
¶ Department of Cardiac Surgery, Children’s Hospital Boston and Harvard Medical School, Boston, Massachusetts.
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Figure 1 Basic Construction of the Patch Delivery Device and the Custom-Designed Stapler
The upper panel shows the polyester patch and the patch delivery device (B). (A and C) Enlargement of B, whereas A shows the back and C the front. The lower panel presents the custom-designed stapler. (E) Enlargement of the front of the custom-designed stapler and a mini Nitinol anchor. (F) Demonstrates how the mini Nitinol anchor is fixated in the plier contained in the stapler.
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Figure 4 Demonstration of the Main Principle of Our New Hybrid Therapy Ex Vivo
(A) The patch delivery device is put on a piece of muscular septum. (B and C) Fixation of a mini Nitinol anchor on the muscular septum with the custom-designed stapler. (D) Fixation of the patch with 7 mini Nitinol anchors. (E) After releasing the sutures the Nitinol frame detaches from the patch. (F) The patch remains with the mini Nitinol anchors in the muscular septum.
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Figure 5 Implantation and Fixation of the Patch
(A) Fluroroscopic images before (left panel) and after (right panel) pulling the Nitinol wire 2. (B) Three-dimensional (3D) echocardiography of the patch and the patch delivery device put on the muscular septum. (C) Three-dimensional echocardiography of the patch and the mini Nitinol anchors after the patch delivery device was drawn back into the 7-F sheath.
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Figure 7 Hemodynamic Stability During the Whole Experiment
Mean arterial pressure (red circles) and central venous pressure (black circles) during the course of the experiment. Application of catecholamines was not necessary. 1 = skin cut; 2 = creation of the muscular ventricular septal defect; 3 = implantation of the patch; 4 = fixation of the patch.
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