Feasibility of transapical cardioscopic surgery in a pig model.

Kofidis, Theo; Duc Vu, Thang; Pal, Shripad N; Vaibavi, Srirangam Ramanujam; Chang, GuoHao; Chua, Yang Chong; Ti, Lian Kah; Lee, Chuen Neng

BACKGROUND AND AIM We introduced a cardioscopic surgical platform for a wide range of cardiac procedures, to address various intracardiac pathologies, through the left ventricular (LV) apex on the arrested heart. The method involves endoscopic access into the LV cavity; hence the term "transapical cardioscopic surgery (TACS)." METHODS For this proof-of-concept study, we obtained transapical access to the left ventricle in five pigs. A right minithoracotomy was used for cannulation and cardiopulmonary bypass A purse string-secured incision at the apex allows for introduction of a self-made intracavitary expander, 5 mm steerable-tip endoscopic camera as well as 5 and 3 mm endoscopic instruments. RESULTS The trans-apical approach provided a good exposure and an adequate surgical field, which allowed us to perform mitral valve repair, mitral valve replacement, and aortic valve replacement. This approach also enabled excellent access and visualization for atrial ablation and intra-aortic procedures. All animals were rewarmed and weaned off bypass. CONCLUSIONS The proposed transapical cardioscopic platform is feasible for major intra-cardiac procedures.