Early feasibility evaluation of thoracoscopically assisted transcatheter ventricular reconstruction in an experimental model of ischaemic heart failure with left anteroapical aneurysm.
OBJECTIVE
To test the feasibility of a thoracoscopically assisted, off-pump, transcatheter ventricular reconstruction (TCVR) approach in an ovine model of left ventricular (LV) anteroapical aneurysm.


RESULTS
Myocardial infarction (MI) was induced by coil occlusion of the middle left anterior descending artery and diagonals. Two months after MI creation, TCVR was performed via a minimal thoracotomy in eight sheep. Under endoscopic and fluoroscopic guidance, trans-interventricular septal puncture was performed from the LV epicardial scar. A guidewire was externalised via a snare placed in the right ventricle from the external jugular vein. An internal anchor was inserted over the wire and positioned on the right ventricular septum and an external anchor was deployed on the LV anterior epicardium. Serial pairs of anchors were placed and plicated together to exclude the scar completely. Immediately after TCVR, echocardiography showed LV end-systolic volume decreased from pre-procedure 58.8±16.6 ml to 25.1±7.6 ml (p<0.01) and the ejection fraction increased from 32.0±7.3% to 52.0±7.5% (p<0.01). LV twist significantly improved (3.83±2.21 vs. pre-procedure -0.41±0.94, p=0.01) and the global peak-systolic longitudinal strain increased from -5.64% to -10.77% (p<0.05).


CONCLUSIONS
TCVR using minimally invasive access techniques on the off-pump beating heart is feasible and resulted in significant improvement in LV performance.
CRF Skirball Center for Innovation, Cardiovascular Research Foundation, Orangeburg, NY, USA.
Yanping
Y
Cheng
Geng-Hua
GH
Yi
Lon S
LS
Annest
Kevin
K
Van Bladel
Ryan
R
Brown
Andrew
A
Wechsler
Masahiko
M
Shibuya
Gerard B
GB
Conditt
Athanasios
A
Peppas
Greg L
GL
Kaluza
Juan F
JF
Granada
D000818:Animals; D056988:Anterior Wall Myocardial Infarction / Q000150:complications; D006328:Cardiac Catheterization / Q000379:methods*; D004195:Disease Models, Animal; D005240:Feasibility Studies; D006322:Heart Aneurysm / Q000209:etiology / Q000601:surgery*; D006333:Heart Failure / Q000209:etiology / Q000601:surgery*; D006352:Heart Ventricles / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012756:Sheep; D013906:Thoracoscopy / Q000379:methods*; D016896:Treatment Outcome; D016277:Ventricular Function, Left