Evaluation of a new hybrid technique for closure of muscular ventricular septal defects in a long-term setting

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 138; no. 2; pp. 365 - 373
• Main Authors: Kozlik-Feldmann, Rainer, MD, Lang, Nora, MD, Lehner, Anja, MS, Sigler, Matthias, MD, Schmitz, Christoph, MD, Sodian, Ralf, MD, Freudenthal, Franz, MD, Dalla-Pozza, Robert, MD, Vasilyev, Nicolay V., MD, del Nido, Pedro J., MD, PhD, Netz, Heinrich, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.08.2009; AATS/WTSA; Elsevier
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Animals; Biological and medical sciences; Cardiology. Vascular system; Cardiothoracic Surgery; Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava; Heart; Heart Septal Defects, Ventricular - diagnostic imaging; Heart Septal Defects, Ventricular - pathology; Heart Septal Defects, Ventricular - physiopathology; Heart Septal Defects, Ventricular - surgery; Heart Septum - pathology; Hemodynamics; Medical sciences; Pneumology; Polyesters; Prostheses and Implants; Swine; Swine, Miniature; Thoracic Surgery - methods; Ultrasonography; scanning electron microscopy; left ventricle; 28; mVSD; PCWP; LV; pulmonary capillary wedge pressure; FS; pulmonary arterial pressure; muscular ventricular septal defect; CPB; cardiopulmonary bypass; SEM; PAP; 20; fractional shortening; Evaluation; Ventricular septal defect; Closure; Setting; Cardiovascular disease; Intracardiac defect; Congenital disease; Long term; Malformation; Heart disease; Anesthesia; Circulatory system; Technique; Cardiology
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2009.02.014

Objective Therapy for muscular ventricular septal defects beyond the moderator band, especially in neonates and infants, has always been challenging for both surgeons and cardiologists. Recently, we established a patch closure hybrid therapy for muscular ventricular septal defects. In this study, we evaluated it in a long-term porcine model. Methods Thirteen minipigs underwent anterolateral thoracotomy to expose the left ventricle. Muscular ventricular septal defects were created under 2- and 3-dimensional echocardiographic guidance with a 7.5-mm sharp punch instrument. Closure of the defects was undertaken with our new patch system in hybrid technique. Animals were observed for 3 months. Echocardiographic evaluation and pathologic examination, including immunohistochemical staining, were undertaken. Results Defects were successfully created in 12 pigs and closed in 10 pigs. Seven survived for 3 months. Residual shunting was noticed in 1 animal. Neither left ventricular dysfunction nor relevant damage to the valves could be detected. Pathologic examination showed complete endothelialization of the patch and the nitinol anchors without protruding parts of the system. Cellular organization was proceeding. Immunohistochemical staining demonstrated endothelial cells on the surface of the patch and fibromuscular cells around the patch. Conclusion Our hybrid therapy was efficacious in closing muscular ventricular septal defects without impairment of cardiac function. The patch system and nitinol anchors demonstrated good integration into the septum. Further development of the system for human application is already being undertaken.