Tomislav Mihaljevic, MD, Yoshio Ootaki, MD, PhD, Jason O

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Robotic and Minimally Invasive Cardiac Surgery

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Presentation transcript:

Beating Heart Cardioscopy: A Platform for Real-Time, Intracardiac Imaging Tomislav Mihaljevic, MD, Yoshio Ootaki, MD, PhD, Jason O. Robertson, BS, Amir K. Durrani, BS, Keiji Kamohara, MD, Masatoshi Akiyama, MD, PhD, Faruk Cingoz, MD, Chiyo Ootaki, MD, Raymond Dessoffy, AA, Michael Kopcak, BA, Jenny Liu, BA, Kiyotaka Fukamachi, MD, PhD The Annals of Thoracic Surgery Volume 85, Issue 3, Pages 1061-1065 (March 2008) DOI: 10.1016/j.athoracsur.2007.09.037 Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Schema of the minimally invasive surgical approach. (A) The cardiopulmonary bypass (CPB) circuit maintains the systemic circulation, and the cardiac circuit flushes the heart with clear, oxygenated perfusate to enable visualization of the intracardiac structures during beating heart surgery. Multi-port catheters may be used for introduction of instruments into the chambers including endoscopes. (B) Percutaneous cannulation is depicted, including a femoral-femoral bypass and the cardiac circuit. The Annals of Thoracic Surgery 2008 85, 1061-1065DOI: (10.1016/j.athoracsur.2007.09.037) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Schema of the actual surgical approach. Cardiopulmonary bypass (CPB) was conducted between the aorta and vena cavae. The endoscope (equipped with a sheath to enable infusion of perfusate) was inserted from the right atrial appendage, left atrial appendage, or left ventricular apex. The Annals of Thoracic Surgery 2008 85, 1061-1065DOI: (10.1016/j.athoracsur.2007.09.037) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Endoscope sheath. This provides a clear-viewing chamber and a port for infusion of perfusate to enhance visualization. The endoscope is advanced through the left end of the sheath and a Bio-Pump line (Medtronic, Inc, Minneapolis, MN) is attached to the spigot at the bottom. The Annals of Thoracic Surgery 2008 85, 1061-1065DOI: (10.1016/j.athoracsur.2007.09.037) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Images acquired from the beating heart: (A) trabeculae of the right ventricle with arrows indicating the blood from the Thebesian circulation; (B) the mitral valve and papillary muscle; (C) the aortic valve during diastole; (D) the aortic valve during early systole; and (E) the right ventricular papillary muscle. The Annals of Thoracic Surgery 2008 85, 1061-1065DOI: (10.1016/j.athoracsur.2007.09.037) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions