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J Thorac Cardiovasc Surg 2005;130:1348-1357
© 2005 The American Association for Thoracic Surgery

Evolving Technology

Three-dimensional echo-guided beating heart surgery without cardiopulmonary bypass: Atrial septal defect closure in a swine model

^a Department of Cardiac Surgery and Cardiology, Children's Hospital and Harvard Medical School, Boston, Mass
^b Department of Aerospace and Mechanical Engineering, Boston University, Boston, Mass
^c Division of Engineering and Applied Sciences, Harvard University, Cambridge, Mass

Read at the Eighty-fifth Annual Meeting of The American Association for Thoracic Surgery, San Francisco, Calif, April 10-13, 2005.

Received for publication March 28, 2005; revisions received June 20, 2005; accepted for publication June 28, 2005.

^_* Address for reprints: Pedro J. del Nido, MD, Department of Cardiac Surgery, Children's Hospital-Boston, 300 Longwood Ave, Boston, MA 02115 (Email: pedro.delnido{at}tch.harvard.edu).

OBJECTIVE: In this study, we tested 3 techniques of atrial septal defect closure under real-time 3-dimensional echocardiography guidance in a swine model.

METHODS: The operations were conducted under the sole guidance of a modified real-time 3-dimensional echocardiography guidance system with a x4 matrix transducer (Sonos 7500, Philips Medical Systems, Andover, Mass). Eighteen swine were anesthetized, and after median sternotomy, the echo probe was applied directly to the surface of the right atrium. To create an atrial septal defect, balloon atrial septostomy and atrial septal defect enlargement were performed. Subsequently, 3 different techniques of atrial septal defect closure were attempted: group I, direct suture closure; group II, closure of the atrial septal defect using the Amplatzer device (AGA Medical Corp, Golden Valley, Minn); and group III, patch closure of the atrial septal defect (n = 6 each).

RESULTS: Real-time 3-dimensional echocardiography guidance provided sufficient spatial resolution and a satisfactory frame rate to provide a "virtual surgeon's view" of the relevant anatomy during the entire procedure. All atrial septal defects were enlarged, and the mean final size was 8.5 ± 1.8 mm. Atrial septal defect closure was successfully accomplished with all the 3 surgical techniques examined. In groups I and III, the needles (1-3 sutures) and staples (6-12 staples) penetrated the tissue and patch material consistently, whereas in group III, the Amplatzer atrial septal defect device was easily deployed. There was no incident device/staple embolization or air introduction. Neither intraoperative 2-dimensional color Doppler echocardiography nor postmortem macro-evaluation revealed any residual shunts.

CONCLUSIONS: Beating heart atrial septal defect closure under real-time 3-dimensional echocardiographic guidance is feasible and, unlike catheter-based devices, applicable for any type of secundum atrial septal defect.

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