Cardioscopy New Platform for Less Invasive Surgery on the Beating Heart

心镜检查新平台，用于对跳动的心脏进行微创手术

• 批准号: 8374367
• 负责人: Tomislav Mihaljevic
• 金额: $ 23.55万
• 依托单位: CLEVELAND CLINIC LERNER COM-CWRU
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-08-10 至 2014-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8374367
• 关键词: Abdomen; Acute; Anatomy; Animal Model; Animals; Biological Preservation; Blood; Blood Circulation; Bypass; Caliber; Cannulas; Cardiac Surgery procedures; Cardiopulmonary Bypass; Cardioscopes; Carotid Arteries; Catheters; Chest; Clip; Complex; Congenital Heart Defects; Coronary Circulation; Defect; Devices; Endoscopes; Environment; Equipment; Evaluation; Excision; Feedback; Flushing; Goals; Heart; Heart Arrest; Heart Diseases; Hypertrophic Cardiomyopathy; Image; Imagery; Imaging Device; Imaging Techniques; Injury; Intervention; Left; Left ventricular structure; Liquid substance; Methods; Mitral Valve; Modality; Morbidity - disease rate; Morphology; Movement; Myocardial; Operating Rooms; Operative Surgical Procedures; Output; Patients; Performance; Perfusion; Peripheral; Polytetrafluoroethylene; Procedures; Pulmonary Circulation; Pulmonary artery structure; Pump; Repeat Surgery; Research; Right ventricular structure; Risk; Secure; Side; Simulate; Sternotomy; Structure; Surgical complication; Surgical incisions; Surgical sutures; System; Techniques; Testing; Thoracic Surgical Procedures; Thoracotomy; Time; Tube; Veins; Vent; Vision; Visual; Weaning; aortic valve; base; clinical application; coronary perfusion; femoral artery; flexibility; heart visualization; hemodynamics; high risk; mortality; novel strategies; older patient; operation; pressure; prevent; prototype; repaired; research study; stomach cardia; success; tool

DESCRIPTION (provided by applicant): Conventional cardiac surgery provides excellent access and visualization for correction of structural heart defects; however, it requires opening the chest and operating on an arrested, non-beating heart. Although endoscopic surgery has been successfully used in abdominal and thoracic surgery, difficulties in obtaining a clear and wide field of vision in blood have prevented its use in cardiac surgery. We have developed a novel approach for clear visualization of intracardiac anatomy in the beating heart using a flexible fiberoptic cardioscope and two extracorporeal bypass circuits. The primary cardiopulmonary bypass circuit secures hemodynamic stability by providing systemic and coronary perfusion. The second imaging circuit is used to isolate the heart from the systemic circulation by perfusing a clear fluid through the heart chambers for intracardiac visualization. Preservation of normal heart movement and clear visualization of intracardiac structures should allow for safer and more effective surgical interventions while avoiding the risk of myocardial injury that can occur in an arrested heart. Iterative surgical interventions can be performed within a beating heart guided by functional intracardiac evaluation without the risk of sudden hemodynamic compromise. In valve repair/replacement and annuloplasty procedures, the clinician can evaluate valve function and morphology during annular contractions before and after intervention. The goal of this proposal is to establish clinically applicable, less invasive nd percutaneous approaches to intracardiac surgery under direct visualization in the beating heart. To achieve our goal, we have three specific aims. Specific Aim 1 is to develop and test a simplified imaging bypass circuit and cannulae to visualize intracardiac structures on the left side of the heart using less invasive surgical and percutaneous approaches to the LV. The imaging bypass circuit will be between the pulmonary artery (PA) (outlet) and the left ventricle (LV) (return). A PA balloon cannula placed from a peripheral vein will be used to occlude the PA, isolate the LV from the right ventricle and flush blood out of the pulmonary circulation into the LV using a clear imaging fluid. The imaging fluid return cannula and the cardioscope will be placed into the LV. Specific Aim 2 and 3 are to validate that both a less invasive and percutaneous visualization system will allow for the safe and effective performance of intracardiac surgeries on a beating heart in an animal model. These include mitral valve repair and the resection of parts of the LV septal wall. The Cardioscope will be placed near the LV apex via a small thoracotomy or small subxiphoid incision or across the aortic valve via the carotid or femoral artery percutaneous approach. The successful completion of this research will provide clinicians with a versatile less invasive platform for closed-chest, intracardiac surgery o electrophysiological interventions in a beating heart. This technique could replace many invasive surgical procedures that require a sternotomy, eliminate added risks from re-operations and provide a safer approach for high risk and elderly patients with valve regurgitation. PUBLIC HEALTH RELEVANCE: Conventional cardiac surgery provides excellent access and visualization for correction of structural heart defects; however, it requires opening the chest an operating on an arrested, non-beating heart. The goal of this proposal is to establish clinically applicable, less invasive and percutaneous approaches to intracardiac surgery under direct cardiac visualization in a hemodynamically stable beating heart environment using a flexible fiberoptic cardioscope and an extracorporeal clear imaging fluid bypass circuit. The successful completion of this research will provide clinicians with a versatile platform for conducting cardia surgical procedures within a beating heart for a wide range of structural heart diseases including valvular, congenital, and ectrophysiological interventions as well as the potential to provide real time visualization of intracardiac valves and LV wall performance feedback in the operating room. This technique could potentially replace many invasive surgical procedures that require a sternotomy, eliminate the added risks associated with re-operations and provide safer approach for high risk patients and elderly patients with valve regurgitation.

描述（由申请人提供）：常规心脏手术为结构性心脏缺陷的矫正提供了良好的通道和可视化；然而，它需要打开胸腔，对停止跳动的心脏进行手术。虽然内窥镜手术已经成功地应用于腹部和胸部手术，但在血液中获得清晰和宽视野的困难阻碍了它在心脏手术中的应用。我们开发了一种新的方法来清晰地显示心脏跳动时的心内解剖结构，使用柔性光纤心镜和两个体外旁路电路。初级体外循环通过提供全身和冠状动脉灌注来确保血流动力学的稳定性。第二个成像回路是通过向心室灌注透明液体以实现心内显像，将心脏与体循环隔离开来。保持正常的心脏运动和心内结构的清晰可见应该允许更安全、更有效的手术干预，同时避免可能发生在停搏心脏的心肌损伤的风险。反复手术干预可以在心脏跳动的心脏内进行功能评估，而不会有突然血流动力学损害的风险。在瓣膜修复/置换术和环成形术中，临床医生可以评估干预前后环收缩期间的瓣膜功能和形态。本建议的目的是建立临床适用的、微创的经皮心内手术入路，在心脏跳动的直视下进行。为了实现我们的目标，我们有三个具体目标。具体目标1是开发和测试一种简化的成像旁路电路和导管，通过微创手术和经皮入路到达左室，以显示心脏左侧的心内结构。成像旁路将在肺动脉（PA）（出口）和左心室（LV）（回流）之间。从外周静脉放置的左室球囊插管将用于闭塞左室，将左室与右心室隔离，并使用透明显像液将肺循环中的血液冲洗到左室。将显像回液套管和心镜置入左室。具体目标2和3是验证微创和经皮可视化系统将允许在动物模型中对跳动的心脏进行安全有效的心内手术。这些包括二尖瓣修复和左室间隔壁部分切除。心镜将通过小开胸或小剑突下切口放置在左室顶点附近，或经颈动脉或股动脉经皮入路放置在主动脉瓣上。这项研究的成功完成将为临床医生提供一个多功能的微创平台，用于对跳动的心脏进行闭胸、心内手术或电生理干预。这项技术可以取代许多需要胸骨切开的侵入性外科手术，消除再次手术的额外风险，并为高风险和老年瓣膜反流患者提供更安全的方法。