title: Surgical access via right thoracotomy facilitates tricuspid valve surgery in sheep.
abstract: In quadrupeds, the three-dimensional orientation of the heart with respect to the thorax is fundamentally different from that in humans. In this study, we assessed the best surgical approach to the tricuspid valve in sheep. Firstly, different surgical access sites to the tricuspid valve were tested in sheep cadavers, the anatomy was analyzed, and the optimal surgical approach to the tricuspid valve was determined. Secondly - along with cardiopulmonary bypass and cardioplegic arrest -the chosen approach was tested in six adult sheepin vivo. Anatomical analyses revealed that a left thoracotomy provided optimal access to the aorta and left heart. However, visualization of the right heart was significantly impaired. In contrast, a right thoracotomy provided good access to the right heart, but the ascending aorta was difficult to approach. Therefore, in thein vivostudies, arterial cannulation was performed through a carotid (n = 4) or femoral (n = 2) artery. In conclusion, a right-sided thoracotomy allows good visualization of all components of the tricuspid valve complex in sheep, but not of the ascending aorta. Consequently, peripheral vessels are preferred for arterial cannulation. This work may stimulate the investigation of pathomechanisms and/or novel treatment options for tricuspid valve pathologies.
authors.affiliation: Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University, Jena 07747, Germany.|Department of Cardiovascular Surgery, Heart Center, University of Freiburg, Freiburg 79110, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Bothe
authors.affiliation: Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University, Jena 07747, Germany.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Diab
authors.affiliation: Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University, Jena 07747, Germany.
authors.forename: Romanus
authors.initials: R
authors.lastname: Ostermann
authors.affiliation: Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University, Jena 07747, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Schwarzer
authors.affiliation: Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University, Jena 07747, Germany.
authors.forename: Luisa
authors.initials: L
authors.lastname: Woelfel
authors.affiliation: Institute of Laboratory Animals Science and Welfare, Jena University Hospital, Friedrich Schiller University, Jena 07747, Germany.
authors.forename: Sabine
authors.initials: S
authors.lastname: Bischoff
authors.affiliation: Institute of Laboratory Animals Science and Welfare, Jena University Hospital, Friedrich Schiller University, Jena 07747, Germany.
authors.forename: Harald
authors.initials: H
authors.lastname: Schubert
authors.affiliation: Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University, Jena 07747, Germany.
authors.forename: Torsten
authors.initials: T
authors.lastname: Doenst
mesh_terms: D000818:Animals; D005260:Female; D012756:Sheep / Q000601:surgery*; D013908:Thoracotomy / Q000662:veterinary*; D014261:Tricuspid Valve / Q000601:surgery*
keywords: animal model; cardiac surgery; tricuspid valve