Long-term pericardial catheterization is associated with minimum foreign-body response.
OBJECTIVE
The goals of this study were to assess the feasibility and to characterize the foreign-body response of a long-term catheter in the pericardium.


BACKGROUND
Long-term access to the normal pericardial space provides opportunities for diagnostic sampling and therapeutic intervention.


METHODS
After thoracotomy, in 7 anesthetized canines, the pericardium was opened and a 5 French silicone vascular access catheter was advanced 10 cm into the pericardial sac toward the apex of the heart. A hydraulic coronary balloon occluder was implanted (N=6). Pericardium was sealed with Prolene suture. Catheters were tunneled to the nape of the neck, attached to a subcutaneous vascular access port, and buried in the fascia. Animals underwent multiple experimental coronary artery occlusions across months. At sacrifice, we assessed the histopathological response of pericardium and epicardium to chronically indwelling silicone catheters.


RESULTS
Post-mortem examinations were performed at 213 days post-operatively (mean, range=96-413, N=6), with one animal maintained for longer-term study. At sacrifice, all catheters were bidirectionally patent and completely mobile in the pericardium without evidence of tissue overgrowth around the intrapericardial segment. Adhesion tissue was found only at the site of catheter entry through the pericardium. Microscopic histopathological examination at catheter entry site, surrounding pericardium, and myocardium revealed minimum chronic inflammation.


CONCLUSIONS
This subcutaneous system provides dependable, chronic access to the normal pericardial space for drug delivery and sampling. The presence of a chronic silicone catheter in the pericardium does not precipitate clinically significant pathologic changes even after repeated ischemic events.
Bartoli
Carlo R
CR
Molecular and Integrative Physiological Sciences Program, Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, and Department of Pathology, Brigham and Women's Hospital 02115, USA.
Akiyama
Ichiro
I
Godleski
John J
JJ
Verrier
Richard L
RL
D000818:Animals; D006328:Cardiac Catheterization / Q000295:instrumentation*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D004195:Disease Models, Animal; D004285:Dogs; D004867:Equipment Design; D005240:Feasibility Studies; D005549:Foreign-Body Reaction / Q000209:etiology* / Q000473:pathology; D006801:Humans; D017202:Myocardial Ischemia / Q000473:pathology; D009206:Myocardium / Q000473:pathology; D010496:Pericardium / Q000473:pathology*; D012828:Silicones; D013997:Time Factors; D016896:Treatment Outcome
D012828:Silicones