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J Thorac Cardiovasc Surg 2006;131:427-432
© 2006 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Robotically assisted perventricular closure of perimembranous ventricular septal defects: Preliminary results in Yucatan pigs

^a Joint Division of Pediatric Cardiology, University of Nebraska/Creighton University, Children's Hospital of Omaha, Omaha, Neb
^b Stanford University Medical Center, Palo Alto, Calif
^c Children's Health Care Minneapolis, Minneapolis, Minn

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

Received for publication August 15, 2005; revisions received October 10, 2005; accepted for publication October 20, 2005.

^_* Address for reprints: Zahid Amin, MD, Children's Hospital of Omaha, 8200 Dodge St, 4th Floor Health Care Pavilion, Omaha, NE 68114 (Email: zamin{at}chsomaha.org).

OBJECTIVE: Robotic systems allow surgeons to perform minimally invasive cardiac surgery in adults. Experience in the pediatric population, however, is limited. Perventricular closure of muscular ventricular septal defects has been reported in humans but requires a median sternotomy. The objective of this study was to assess the feasibility of robotically assisted closure of perimembranous ventricular septal defects by using the perventricular approach.

METHODS: The procedure was attempted in 7 pigs with naturally occurring perimembranous ventricular septal defects. Echocardiography was performed to confirm the presence and assess the size of the defect. A 3-armed da Vinci system consisting of two 8-mm instrument ports and a 12-mm endoscopy port was used. A pericardiotomy was performed, and the right ventricular free wall was visualized. A spinal needle was advanced into the right ventricular cavity. By using echocardiographic guidance, a glide wire was advanced through the angiocatheter and manipulated through the defect into the left ventricle or the ascending aorta. A delivery sheath was advanced over the wire. An appropriately sized Amplatzer device was deployed through the sheath.

RESULTS: The procedure was successful in 5 pigs. One device was removed because it was smaller than the defect and an appropriately sized device was not available. The placement failed in the second pig in the series. Four pigs were followed up for 1 to 4 months. Angiograms performed before the pigs were killed documented complete occlusion in 3 and mild-to-moderate shunt in 1.

CONCLUSIONS: Robotically assisted perventricular closure with the Amplatzer Membranous VSD Occluder is feasible. This approach avoids the associated morbidities of cardiopulmonary bypass and median sternotomy. Further investigation and refinements are needed, however, before application of this approach in humans.

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