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J Thorac Cardiovasc Surg 2009;138:365-373
© 2009 The American Association for Thoracic Surgery

Congenital Heart Disease

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

^a Department of Pediatric Cardiology, Hospital Campus Grosshadern, University of Munich Hospital—Großhadern, Munich, Germany
^b Department of Cardiac Surgery, Hospital Campus Grosshadern, University of Munich Hospital—Großhadern, Munich, Germany
^c Department of Pediatric Cardiology and Intensive Care, Georg August University, Göttingen, Germany
^d Department of Pediatric Cardiology, Kardiozentrum, La Paz, Bolivia
^e Department of Cardiac Surgery, Children's Hospital Boston and Harvard Medical School, Boston, Mass

Received for publication October 8, 2008; revisions received January 11, 2009; accepted for publication February 9, 2009.

^_* Address for reprints: Rainer Kozlik-Feldmann, MD, Department of Pediatric Cardiology, Hospital Campus Grosshadern, University of Munich Hospital—Großhadern, Marchioninistraße 15, D-81377 Munich, Germany. (Email: kozlik-f{at}lrz.uni-muenchen.de).

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.