title: Cardioscopy-guided surgery: intracardiac mitral and tricuspid valve repair under direct visualization in the beating heart.
abstract: OBJECTIVE
  Cardioscopy is a novel imaging method that allows closed-chest, real-time fiberoptic imaging of intracardiac structures. This study tested the feasibility and safety of cardioscopy as a platform for mitral and tricuspid valve surgery in the beating heart.
  
  
  METHODS
  Through a median sternotomy, cardiopulmonary bypass was established in 10 calves. Lactated Ringer's solution was administered through the pulmonary artery to eliminate residual blood volumes in the lung vasculature and was drained through a left ventricular cannula. A fiberoptic cardioscope within its translucent outer sheath was inserted through the left ventricle. Irrigating solution was continuously administered through the cardioscope sheath for clearer visualization. An endoscopic clip was used for edge-to-edge repair of the mitral and tricuspid valves. After mitral valve clipping, the cardioscope was inserted into the right ventricle. The solution was administered from the right atrium and continuously drained from the pulmonary artery. After tricuspid valve repair, the animal was weaned from cardiopulmonary bypass.
  
  
  RESULTS
  Successful double-valve repair was carried out in all 10 cases. All calves were weaned from cardiopulmonary bypass with dobutamine only. Hematocrit values were maintained during the procedure (pre 29.0% ± 3.1% vs post 28.5% ± 3.6%, P = .70).
  
  
  CONCLUSIONS
  This study showed the technical feasibility of beating heart valve surgery using direct cardioscopic visualization. Cardioscopy represents a promising platform for future interventions and surgery under direct visualization in the beating heart.
authors.affiliation: Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
authors.forename: Akira
authors.initials: A
authors.lastname: Shiose
authors.forename: Tohru
authors.initials: T
authors.lastname: Takaseya
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Fumoto
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Horai
authors.forename: Hyun-Il
authors.initials: HI
authors.lastname: Kim
authors.forename: Kiyotaka
authors.initials: K
authors.lastname: Fukamachi
authors.forename: Tomislav
authors.initials: T
authors.lastname: Mihaljevic
mesh_terms: D058665:Adrenergic beta-1 Receptor Agonists / Q000008:administration & dosage; D000818:Animals; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation; D002315:Cardiopulmonary Bypass; D002417:Cattle; D004280:Dobutamine / Q000008:administration & dosage; D019723:Endoscopes; D004724:Endoscopy / Q000009:adverse effects / Q000295:instrumentation; D004867:Equipment Design; D005240:Feasibility Studies; D005336:Fiber Optic Technology; D006400:Hematocrit; D007552:Isotonic Solutions / Q000008:administration & dosage; D008297:Male; D008943:Mitral Valve / Q000601:surgery*; D023421:Models, Animal; D000077325:Ringer's Lactate; D056346:Sternotomy; D013525:Surgical Instruments; D007507:Therapeutic Irrigation; D014261:Tricuspid Valve / Q000601:surgery*
chemical_list: D058665:Adrenergic beta-1 Receptor Agonists; D007552:Isotonic Solutions; D000077325:Ringer's Lactate; D004280:Dobutamine