title: Feasibility of transapical cardioscopic surgery in a pig model.
abstract: OBJECTIVE
  We introduced a cardioscopic surgical platform for a wide range of cardiac procedures, to address various intracardiac pathologies, through the left ventricular (LV) apex on the arrested heart. The method involves endoscopic access into the LV cavity; hence the term "transapical cardioscopic surgery (TACS)."
  
  
  METHODS
  For this proof-of-concept study, we obtained transapical access to the left ventricle in five pigs. A right minithoracotomy was used for cannulation and cardiopulmonary bypass A purse string-secured incision at the apex allows for introduction of a self-made intracavitary expander, 5 mm steerable-tip endoscopic camera as well as 5 and 3 mm endoscopic instruments.
  
  
  RESULTS
  The trans-apical approach provided a good exposure and an adequate surgical field, which allowed us to perform mitral valve repair, mitral valve replacement, and aortic valve replacement. This approach also enabled excellent access and visualization for atrial ablation and intra-aortic procedures. All animals were rewarmed and weaned off bypass.
  
  
  CONCLUSIONS
  The proposed transapical cardioscopic platform is feasible for major intra-cardiac procedures.
authors.affiliation: Department of Surgery, National University of Singapore, Singapore, Singapore; Department of Cardiothoracic and Vascular Surgery, National University Health System, Singapore, Singapore.
authors.forename: Theo
authors.initials: T
authors.lastname: Kofidis
authors.forename: Thang
authors.initials: T
authors.lastname: Duc Vu
authors.forename: Shripad N
authors.initials: SN
authors.lastname: Pal
authors.forename: Srirangam Ramanujam
authors.initials: SR
authors.lastname: Vaibavi
authors.forename: GuoHao
authors.initials: G
authors.lastname: Chang
authors.forename: Yang Chong
authors.initials: YC
authors.lastname: Chua
authors.forename: Lian Kah
authors.initials: LK
authors.lastname: Ti
authors.forename: Chuen Neng
authors.initials: CN
authors.lastname: Lee
mesh_terms: D000818:Animals; D001021:Aortic Valve / Q000601:surgery; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002315:Cardiopulmonary Bypass; D002404:Catheterization / Q000379:methods; D004724:Endoscopy / Q000295:instrumentation / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006324:Heart Arrest, Induced; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006352:Heart Ventricles; D008943:Mitral Valve / Q000601:surgery; D023421:Models, Animal; D013552:Swine; D013908:Thoracotomy / Q000379:methods