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Sizarov A, Boudjemline Y. Novel materials and devices in the transcatheter management of congenital heart diseases – the future comes slowly (part 1). Arch Cardiovasc Dis 2016; 109:278-85. [DOI: 10.1016/j.acvd.2015.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 11/23/2015] [Accepted: 12/17/2015] [Indexed: 10/22/2022]
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Ataollahi A, Berra I, Vasilyev NV, Machaidze Z, Dupont PE. Cardioscopic Tool-delivery Instrument for Beating-heart Surgery. IEEE/ASME TRANSACTIONS ON MECHATRONICS : A JOINT PUBLICATION OF THE IEEE INDUSTRIAL ELECTRONICS SOCIETY AND THE ASME DYNAMIC SYSTEMS AND CONTROL DIVISION 2016; 21:584-590. [PMID: 26951754 PMCID: PMC4778079 DOI: 10.1109/tmech.2015.2494842] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This paper describes an instrument that provides solutions to two open challenges in beating-heart intracardiac surgery - providing high-fidelity imaging of tool-tissue contact and controlling tool penetration into tissue over the cardiac cycle. Tool delivery is illustrated in the context of tissue removal for which these challenges equate to visualization of the tissue as it is being removed and to control of cutting depth. Cardioscopic imaging is provided by a camera and illumination system encased in an optical window. When the optical window is pressed against tissue, it displaces the blood between the camera and tissue allowing clear visualization. Control of cutting depth is achieved via precise extension of the cutting tool from a port in the optical window. Successful tool use is demonstrated in ex vivo and in vivo experiments.
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Affiliation(s)
- Asghar Ataollahi
- A. Ataollahi, I. Berra, N. Vasilyev, Z. Machaidze and P. Dupont are with Cardiovascular Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, 02115, USA. {first.last}@childrens.harvard.edu
| | - Ignacio Berra
- A. Ataollahi, I. Berra, N. Vasilyev, Z. Machaidze and P. Dupont are with Cardiovascular Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, 02115, USA. {first.last}@childrens.harvard.edu
| | - Nikolay V Vasilyev
- A. Ataollahi, I. Berra, N. Vasilyev, Z. Machaidze and P. Dupont are with Cardiovascular Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, 02115, USA. {first.last}@childrens.harvard.edu
| | - Zurab Machaidze
- A. Ataollahi, I. Berra, N. Vasilyev, Z. Machaidze and P. Dupont are with Cardiovascular Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, 02115, USA. {first.last}@childrens.harvard.edu
| | - Pierre E Dupont
- A. Ataollahi, I. Berra, N. Vasilyev, Z. Machaidze and P. Dupont are with Cardiovascular Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, 02115, USA. {first.last}@childrens.harvard.edu
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Lang N, Merkel E, Fuchs F, Schumann D, Klemm D, Kramer F, Mayer-Wagner S, Schroeder C, Freudenthal F, Netz H, Kozlik-Feldmann R, Sigler M. Bacterial nanocellulose as a new patch material for closure of ventricular septal defects in a pig model. Eur J Cardiothorac Surg 2014; 47:1013-21. [PMID: 25064053 DOI: 10.1093/ejcts/ezu292] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 06/19/2014] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Current materials for closure of cardiac defects such as ventricular septal defects (VSDs) are associated with compliance mismatch and a chronic inflammatory response. Bacterial nanocellulose (BNC) is a non-degradable biomaterial with promising properties such as high mechanical strength, favourable elasticity and a negligible inflammatory reaction. The aim of this study was the evaluation of a BNC patch for VSD closure and the investigation of its in vivo biocompatibility in a chronic pig model. METHODS Young's modulus and tensile strength of BNC patches were determined before and after blood exposure. Muscular VSDs were created and closed with a BNC patch on the beating heart in an in vivo pig model. Hearts were explanted after 7, 30 or 90 days. Macropathology, histology and immunohistochemistry were performed. RESULTS Young's modulus and tensile strength of the BNC patch decreased after blood contact from 6.3 ± 1.9 to 3.86 ± 2.2 MPa (P < 0.01) and 0.33 ± 0.06 to 0.26 ± 0.06 MPa (P < 0.01), respectively, indicating the development of higher elasticity. Muscular VSDs were closed with a BNC patch without residual shunting. After 90 days, a mild chronic inflammatory reaction was present. Moreover, there was reduced tissue overgrowth in comparison with polyester. Proceeding cellular organization characterized by fibromuscular cells, production of extracellular matrix, neoangiogenesis and complete neoendothelialization were found. There were no signs of thrombogenicity. CONCLUSIONS BNC patches can close VSDs with good mid-term results and its biocompatibility can be considered as satisfactory. Its elasticity increases in the presence of blood, which might be advantageous. Therefore, it has potential to be used as an alternative patch material in congenital heart disease.
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Affiliation(s)
- Nora Lang
- Department of Pediatric Cardiology and Intensive Care Medicine, Ludwig-Maximilians-University, Munich, Germany Department of Congenital Heart Defects and Pediatric Cardiology, Heart Center, University of Freiburg, Freiburg, Germany
| | - Elena Merkel
- Department of Pediatric Cardiology and Intensive Care Medicine, Ludwig-Maximilians-University, Munich, Germany
| | - Franziska Fuchs
- Department of Pediatric Cardiology and Intensive Care Medicine, Ludwig-Maximilians-University, Munich, Germany
| | | | | | | | - Susanne Mayer-Wagner
- Department of Orthopedic Surgery, Ludwig-Maximilians-University, Munich, Germany
| | - Christian Schroeder
- Department of Orthopedic Surgery, Ludwig-Maximilians-University, Munich, Germany
| | | | - Heinrich Netz
- Department of Pediatric Cardiology and Intensive Care Medicine, Ludwig-Maximilians-University, Munich, Germany
| | - Rainer Kozlik-Feldmann
- Department of Pediatric Cardiology and Intensive Care Medicine, Ludwig-Maximilians-University, Munich, Germany
| | - Matthias Sigler
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg-August-University Göttingen, Göttingen, Germany
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Abstract
The surgical repair of complex congenital heart defects frequently requires additional tissue in various forms, such as patches, conduits, and valves. These devices often require replacement over a patient's lifetime because of degeneration, calcification, or lack of growth. The main new technologies in congenital cardiac surgery aim at, on the one hand, avoiding such reoperations and, on the other hand, improving long-term outcomes of devices used to repair or replace diseased structural malformations. These technologies are: 1) new patches: CorMatrix® patches made of decellularized porcine small intestinal submucosa extracellular matrix; 2) new devices: the Melody® valve (for percutaneous pulmonary valve implantation) and tissue-engineered valved conduits (either decellularized scaffolds or polymeric scaffolds); and 3) new emerging fields, such as antenatal corrective cardiac surgery or robotically assisted congenital cardiac surgical procedures. These new technologies for structural malformation surgery are still in their infancy but certainly present great promise for the future. But the translation of these emerging technologies to routine health care and public health policy will also largely depend on economic considerations, value judgments, and political factors.
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Affiliation(s)
- David Kalfa
- Pediatric Cardiac Surgery, Columbia University, Morgan Stanley Children's Hospital of New York-Presbyterian, New York, USA
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Vasilyev NV, Dupont PE, del Nido PJ. Robotics and imaging in congenital heart surgery. Future Cardiol 2012; 8:285-96. [PMID: 22413986 DOI: 10.2217/fca.12.20] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The initial success seen in adult cardiac surgery with the application of available robotic systems has not been realized as broadly in pediatric cardiac surgery. The main obstacles include extended set-up time and complexity of the procedures, as well as the large size of the instruments with respect to the size of the child. Moreover, while the main advantage of robotic systems is the ability to minimize incision size, for intracardiac repairs, cardiopulmonary bypass is still required. Catheter-based interventions, on the other hand, have expanded rapidly in both application as well as the complexity of procedures and lesions being treated. However, despite the development of sophisticated devices, robotic systems to aid catheter procedures have not been commonly applied in children. In this article, we describe new catheter-like robotic delivery platforms, which facilitate safe navigation and enable complex repairs, such as tissue approximation and fixation, and tissue removal, inside the beating heart. Additional features including the tracking of rapidly moving tissue targets and novel imaging approaches are described, along with a discussion of future prospects for steerable robotic systems.
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Laing G, Dupont PE. Beating-heart mitral valve chordal replacement. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2012; 2011:2476-9. [PMID: 22254843 DOI: 10.1109/iembs.2011.6090687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Replacing open-heart surgical procedures with beating-heart interventions substantially decreases the trauma and risk of a procedure. One of the most challenging procedures to perform on the beating heart is valve repair. To address this need, this paper proposes a tool for replacing mitral valve chordae to correct regurgitation. The chordae is secured to the papillary muscle and leaflet using NiTi tissue anchors that also incorporate an internal adjustment mechanism to enable initial adjustment as well as subsequent readjustment of chordae length. Efficacy of the proposed tool for chordae replacement and reduction of regurgitation was demonstrated in an ex-vivo heart simulator.
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Affiliation(s)
- Genevieve Laing
- Mechanical Engineering, Boston University, Boston, MA 02215, USA.
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DiBiasio CM, Durand KV, Hopkins J, Traina Z, Slocum AH, Vasilyev NV, del Nido PJ. Design of a Surgical Port for Minimally Invasive Beating-Heart Intracardial Procedures. J Med Device 2011. [DOI: 10.1115/1.4004867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Direct-access, minimally invasive, beating-heart intracardial procedures have the potential to replace many traditional surgical procedures requiring cardio-pulmonary bypass as long as micro-emboli are prevented from entering the cardiovascular system. A new surgical port was developed to introduce surgical instruments into chambers of the beating heart during minimally invasive, intracardial surgical procedures without allowing the introduction of micro-emboli 0.1 mm or larger in size. The design consists of an outer port body that is secured to the heart wall using a purse string suture and a series of inner tubular sleeves that form the interface between the port and the transecting instrument. The design enables rapid tool changes and accommodates a wide variety of instruments. The port uses a fluid purging system to dislodge and remove emboli from a surgical instrument. Laboratory and clinical tests show that the port adequately seals around a surgical instrument and prevents the introduction of emboli with diameters greater than 0.1 mm into the heart while minimizing hemorrhage.
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Affiliation(s)
| | | | | | | | - Alexander H. Slocum
- Massachusetts Institute of Technology, Department of Mechanical Engineering, Cambridge, MA 02139
| | | | - Pedro J. del Nido
- Children’s Hospital of Boston, Department of Cardiac Surgery, Boston, MA 02115
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Vasilyev NV, Kawata M, DiBiasio CM, Durand KV, Hopkins J, Traina ZJ, Slocum AH, del Nido PJ. A novel cardioport for beating-heart, image-guided intracardiac surgery. J Thorac Cardiovasc Surg 2011; 142:1545-51. [PMID: 21855093 DOI: 10.1016/j.jtcvs.2011.07.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Revised: 06/20/2011] [Accepted: 07/11/2011] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Intracardiac beating-heart procedures require the introduction and exchange of complex instruments and devices. To prevent potential complications such as air embolism and bleeding, a universal cardioport was designed and tested. METHODS The design consists of a port body and a series of interchangeable sleeves. The port uses a fluid purging system to remove air from the instrument before insertion into the heart, and a valve system minimizes blood loss during instrument changes. RESULTS The cardioport was tested ex vivo and in vivo in pigs (n = 5). Beating-heart procedures, such as septal defect closure and mitral valve repair, were modeled. Ex vivo trials (n = 150) were performed, and no air emboli were introduced using the port. In comparison, air emboli were detected in 40% to 85% of the cases without the use of the port-based purging system. Port operation revealed excellent ergonomics and minimal blood loss. CONCLUSIONS A novel cardioport system designed to prevent air entry and blood loss from transcardiac instrument introduction was shown to be an enabling platform for intracardiac beating-heart surgery. The port system improves safety and facilitates further development of complex instruments and devices for transcardiac beating-heart surgery.
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Affiliation(s)
- Nikolay V Vasilyev
- Department of Cardiac Surgery, Children's Hospital Boston and Harvard Medical School, Boston, MA 02115, USA.
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Evaluation of Atrial and Ventricular Septal Defects with Real-Time Three-Dimensional Echocardiography: Current Status and Literature Review. CURRENT CARDIOVASCULAR IMAGING REPORTS 2011. [DOI: 10.1007/s12410-011-9102-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lang N, Kozlik-Feldmann R, Meyer-Gold A, Fuchs F, Lehner A, Abicht J, Sodian R, Vasilyev N, del Nido P, Netz H, Reichart B, Schmitz C. Modification of a Hybrid Technique for Closure of Muscular Ventricular Septal Defects in a Pig Model. Heart Surg Forum 2010; 13:E299-304. [DOI: 10.1532/hsf98.20091181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Yuen SG, Vasilyev NV, del Nido PJ, Howe RD. Robotic tissue tracking for beating heart mitral valve surgery. Med Image Anal 2010; 17:1236-42. [PMID: 23973122 DOI: 10.1016/j.media.2010.06.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2009] [Revised: 06/16/2010] [Accepted: 06/21/2010] [Indexed: 11/29/2022]
Abstract
The rapid motion of the heart presents a significant challenge to the surgeon during intracardiac beating heart procedures. We present a 3D ultrasound-guided motion compensation system that assists the surgeon by synchronizing instrument motion with the heart. The system utilizes the fact that certain intracardiac structures, like the mitral valve annulus, have trajectories that are largely constrained to translation along one axis. This allows the development of a real-time 3D ultrasound tissue tracker that we integrate with a 1 degree-of-freedom (DOF) actuated surgical instrument and predictive filter to devise a motion tracking system adapted to mitral valve annuloplasty. In vivo experiments demonstrate that the system provides highly accurate tracking (1.0 mm error) with 70% less error than manual tracking attempts.
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Affiliation(s)
- Shelten G Yuen
- Harvard School of Engineering and Applied Sciences, 29 Oxford Street, Cambridge, MA 02138, USA
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Three-Dimensional Transesophageal Echocardiography Is a Major Advance for Intraoperative Clinical Management of Patients Undergoing Cardiac Surgery. Anesth Analg 2010; 110:1548-73. [DOI: 10.1213/ane.0b013e3181d41be7] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Kawata M, Vasilyev NV, Perrin DP, del Nido PJ. Beating-heart mitral valve suture annuloplasty under real-time three-dimensional echocardiography guidance: an ex vivo study. Interact Cardiovasc Thorac Surg 2010; 11:6-9. [PMID: 20395245 DOI: 10.1510/icvts.2010.233320] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We are developing an alternative mitral valve suture annuloplasty technique on the beating-heart under real-time three-dimensional echocardiography (RT3DE) guidance. The purpose of this initial study was to evaluate a feasibility of this technique using commercially available suturing devices (Sutur Tek Endo 360-degree, Sutur Tek Inc, North Chelmsford, MA, USA). Isolated porcine hearts (n=10) were mounted in a water-filled tank and attached to an ex vivo pulse simulation device, where varying left ventricle pressures with associated valve motion were generated by pulsatile flow through an apical cannula. The suturing device was inserted through the left atrium. Intra-annular (De Vega type) suture annuloplasty was performed under RT3DE guidance. The procedure was successfully performed in all cases. The diameter of the annulus was effectively reduced (85.5+/-4.2% of original antero-posterior dimension, 86.7+/-6.1% of original transverse dimension). The number of tissue bites was 7.4+/-0.8. The maximum distance between the annulus and sutures placed was 1.1 mm. The total procedure time was 9.4+/-2.4 min. There was no collateral tissue injury in any of the cases. This ex vivo study demonstrates the feasibility of beating-heart mitral valve suture annuloplasty under RT3DE guidance.
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Affiliation(s)
- Mitsuhiro Kawata
- Department of Cardiac Surgery, Children's Hospital Boston, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, USA
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Abstract
PURPOSE OF REVIEW Echocardiography in pediatric and congenital heart disease is a key diagnostic technique in patients with congenital heart disease. Due to new technological developments, it has become a rapidly evolving field. RECENT FINDINGS In this review, we focus on recent developments in standardization and validation of standard techniques in pediatric and congenital echocardiography. This is mainly related to standardization of image acquisition and normalization of measurements for body size. The rest of the review is focused on the application of three-dimensional echocardiography, tissue Doppler imaging and Speqle tracking techniques to pediatric heart disease. SUMMARY New developments in standardization of echocardiography, the introduction of three-dimensional echocardiography and new functional techniques such as tissue Doppler and Speqle tracking strengthen the position of pediatric echocardiography as the most important diagnostic tool for patients with congenital heart disease.
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Kozlik-Feldmann R, Lang N, Lehner A, Sigler M, Schmitz C, Sodian R, Freudenthal F, Dalla-Pozza R, Vasilyev NV, del Nido PJ, Netz H. Evaluation of a new hybrid technique for closure of muscular ventricular septal defects in a long-term setting. J Thorac Cardiovasc Surg 2009; 138:365-73. [DOI: 10.1016/j.jtcvs.2009.02.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2008] [Revised: 01/11/2009] [Accepted: 02/09/2009] [Indexed: 11/29/2022]
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