Working heart off-pump cardiac repair (OPCARE)--the next step in robotic surgery?

The objective of the present study was to assess the feasibility of working heart off-pump cardiac repair (OPCARE), for example, for simple congenital defects or valves, with the help of a commercially available surgical robot in order to identify problem areas and to explore potential solutions. OPCARE was studied in four bovine experiments using the Zeus (Computermotion, Santa Barbara, CA, USA) surgical robot providing 3D viewing of the extra cardiac instruments in combination with two intra-cardiac ultrasound visualisation systems (Clearview Ultra, Boston Scientific, La Garenne, France) and Accunav (Accuson, Mountain View, CA, USA) allowing for two different viewing planes of the heart and identification of both, intra-cardiac structures and intra-cardiac robotic instruments. For the given experimental set-up, introduction of robotic instruments into the right atrium (typical for instrumentation during OPCARE), grabbing of the second instrument (typical for removal of intra-cardiac foreign bodies), and grabbing of relatively still atrial structures, which can be visualised by intra-cardiac ultrasound (typical for resection of specific cardiac tissue, clipping of a specific cardiac structure, steered access to other cardiac cavities) have been realised with relative ease.

Myocardial and pulmonary effects of aqueous oxygen with acute hypoxia.

Background: The purpose of this paper was to evaluate myocardial and pulmonary effects of aqueous oxygen (AO) delivered directly into the pulmonary circulation in acute hypoxia.

Methods: Six calves (2 months old, 68.0 +/- 2.

Ultrasound navigation through the heart for off-pump aortic valved stent implantation: new tools for new goals.

Purpose: To validate the use of simultaneous intracardiac and intravascular ultrasound (IVUS) guidance for periprocedural dimension assessment, Residual-Coronary/Sinus-Stent Index (RCSSI) estimation, target site identification, deployment monitoring, and quality control of off-pump aortic Valved Stent implantation.

Methods: Five pigs (56+/-5 kg) underwent off-pump orthotopic aortic valve implantation using a custom-made self-expanding Valved Stent. Intracardiac ultrasound (AcuNav) was introduced via the right femoral vein.

Aqueous oxygen: the solution to relief hypoxic pulmonary hypertension.

Objective: To evaluate the effects of hyperbaric oxygen solution on hypoxic pulmonary hypertension.

Methods: Eleven calves, 2-month-old, 71+/-6 kg, underwent general anaesthesia, mechanical ventilation and median sternotomy. Catheters for continuous pressure and blood gas measurements were inserted in carotid and femoral arteries, left atrium, right atrium and pulmonary artery (PA), and a flow-probe placed around the PA.

In vivo testing of a right heart mini-pump during a 24 hour period: is it safe?

A coaxial atrial cannula connected to a mini-centrifugal pump was developed to bypass the right heart during extreme exposures in off-pump coronary artery bypass surgery. This study was designed to test the effect of this pump, running during 24 hours, on blood elements to evaluate its use as a prolonged right heart support. In a calf model (body weight 68+/-5 kg), the pump was inserted and set to its maximal motor speed of 7000 rpm.

Small intestine without mucosa as a growing vascular conduit: a porcine experimental study.

Objective: This study was conducted to check the feasibility of using small intestine without mucosa as a growing vascular conduit.

Method: Autologous proximal jejunum without mucosa after treatment with heparin bonding was used as a free inferior vena cava interpositional graft between the renal veins and bifurcation of inferior vena cava in 8 piglets. Intravenous ultrasonography was performed at 1 to 3 months after the operation and at autopsy.

Antithrombotic properties of trillium coated connectors.

Trillium coating (Medtronic Inc., Minneapolis, MN) offers, in addition to the presence of heparin, endothelium-like properties of its negatively charged surface. Its thromboresistant properties on coated connectors are tested here and compared with uncoated standard connectors, as well as with the Carmeda BioActive surface (CBAS) heparin surface coating.

An alternative to left ventricular volume reduction.

Background: Left ventricular (LV) remodeling leading to ventricular dilatation is ultimately a maladaptative process according to the law of Laplace. To counteract the wall stress increase, a new concept of reducing the LV cavity radius by changing the LV globular shape to a bilobular one through the insertion of transventricular splints has emerged. This procedure is tested in a model of congestive heart failure.

A new concept of integrated cardiopulmonary bypass circuit.

Objective: Standard cardiopulmonary bypass (CPB) circuits with their large surface area and volume contribute to postoperative systemic inflammatory reaction and hemodilution. In order to minimize these problems a new approach has been developed resulting in a single disposable, compact arterio-venous loop, which has integral kinetic-assist pumping, oxygenating, air removal, and gross filtration capabilities (CardioVention Inc., Santa Clara, CA, USA).

Hemocompatibility of a coaxial pump catheter for less invasive heart surgery.

Off-pump coronary artery bypass (OPCAB) requires heart manipulation during exposure of the lateral and posterior walls of the heart, which may cause hemodynamic instability, mainly through right ventricular dysfunction. A coaxial atrial cannula connected to a minicentrifugal pump was developed to bypass the right heart. This study was designed to test the hemocompatibility of this pump ongoing for 6 h.