title: Off-pump atrial septal defect closure using the universal cardiac introducer®: creation of models of atrial septal defects in the pig access and surgical technique.
abstract: OBJECTIVE
  : Optimal atrial septal defect (ASD) closure should combine off-pump techniques with the effectiveness and versatility of open-heart techniques. We report our experience with off-pump ASD closure using the Universal Cardiac Introducer (UCI) in a porcine model. The goal was to create an ASD over the fossa ovale (FO) and position a patch over the ASD under ultrasound (US) imaging and augmented virtual reality guidance.
  
  
  METHODS
  : An US probe (tracked with a magnetic tracking system) was positioned into the esophagus (transesophageal echocardiographic probe) for real-time image-guidance. The right atrium (RA) of six pigs was exposed via a right lateral thoracotomy or medial sternotomy. The UCI was attached to the RA wall. A punching tool was introduced via the UCI, navigated and positioned, under US guidance, to create an ASD into the FO. A patch with its holder and a stapling device were introduced into the RA via the UCI. The patch was positioned on the ASD. Occlusion of the ASD was determined using US and Doppler imaging.
  
  
  RESULTS
  : The FO membrane was excised successfully in all animals. US image-guidance provided excellent visualization. The patch was positioned in all cases with complete occlusion of the ASD. The stapling device proved too bulky, impeding circumferential positioning.
  
  
  CONCLUSIONS
  : Using the UCI, ASD closure was safe and feasible. US imaging, combined with virtual and augmented reality provided accurate navigating and positioning. This study also provided valuable information on the future design of anchoring devices for intracardiac procedures.
authors.affiliation: From the *Canadian Surgical Technologies and Advance Robotics (CSTAR), Lawson Health Research Institute; †Imaging Group, Robarts Research Institute; Departments of ‡Physiology and Pharmacology, §Medicine, ¶Anaesthesia, and ∥Medical Biophysics, the University of Western Ontario; and London Health Science Center, London, Ontario, Canada.
authors.forename: Gerard M
authors.initials: GM
authors.lastname: Guiraudon
authors.forename: Douglas L
authors.initials: DL
authors.lastname: Jones
authors.forename: Daniel
authors.initials: D
authors.lastname: Bainbridge
authors.forename: John T
authors.initials: JT
authors.lastname: Moore
authors.forename: Chris
authors.initials: C
authors.lastname: Wedlake
authors.forename: Cristian
authors.initials: C
authors.lastname: Linte
authors.forename: Andrew
authors.initials: A
authors.lastname: Wiles
authors.forename: Terry M
authors.initials: TM
authors.lastname: Peters