The Journal of Thoracic and Cardiovascular Surgery
Volume 138, Issue 2 , Pages 365-373, August 2009

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

  • Rainer Kozlik-Feldmann, MD

      Affiliations

    • Department of Pediatric Cardiology, Hospital Campus Grosshadern, University of Munich Hospital—Großhadern, Munich, Germany
    • R.K.-F. and N.L. contributed equally to this article.
    • Corresponding Author InformationAddress for reprints: Rainer Kozlik-Feldmann, MD, Department of Pediatric Cardiology, Hospital Campus Grosshadern, University of Munich Hospital—Großhadern, Marchioninistraße 15, D-81377 Munich, Germany.
    • ,
  • Nora Lang, MD

      Affiliations

    • Department of Pediatric Cardiology, Hospital Campus Grosshadern, University of Munich Hospital—Großhadern, Munich, Germany
    • R.K.-F. and N.L. contributed equally to this article.
    • ,
  • Anja Lehner, MS

      Affiliations

    • Department of Pediatric Cardiology, Hospital Campus Grosshadern, University of Munich Hospital—Großhadern, Munich, Germany
    • ,
  • Matthias Sigler, MD

      Affiliations

    • Department of Pediatric Cardiology and Intensive Care, Georg August University, Göttingen, Germany
    • ,
  • Christoph Schmitz, MD

      Affiliations

    • Department of Cardiac Surgery, Hospital Campus Grosshadern, University of Munich Hospital—Großhadern, Munich, Germany
    • ,
  • Ralf Sodian, MD

      Affiliations

    • Department of Cardiac Surgery, Hospital Campus Grosshadern, University of Munich Hospital—Großhadern, Munich, Germany
    • ,
  • Franz Freudenthal, MD

      Affiliations

    • Department of Pediatric Cardiology, Kardiozentrum, La Paz, Bolivia
    • ,
  • Robert Dalla-Pozza, MD

      Affiliations

    • Department of Pediatric Cardiology, Hospital Campus Grosshadern, University of Munich Hospital—Großhadern, Munich, Germany
    • ,
  • Nicolay V. Vasilyev, MD

      Affiliations

    • Department of Cardiac Surgery, Children's Hospital Boston and Harvard Medical School, Boston, Mass
    • ,
  • Pedro J. del Nido, MD, PhD

      Affiliations

    • Department of Cardiac Surgery, Children's Hospital Boston and Harvard Medical School, Boston, Mass
    • ,
  • Heinrich Netz, MD

      Affiliations

    • Department of Pediatric Cardiology, Hospital Campus Grosshadern, University of Munich Hospital—Großhadern, Munich, Germany

Received 8 October 2008; received in revised form 11 January 2009; accepted 9 February 2009. published online 30 April 2009.

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.

Abbreviations and Acronyms: CPB, cardiopulmonary bypass, FS, fractional shortening, LV, left ventricle, mVSD, muscular ventricular septal defect, PAP, pulmonary arterial pressure, PCWP, pulmonary capillary wedge pressure, SEM, scanning electron microscopy

CTSNet classification: 20, 28

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 Supported by Elterninitiative Großhadern eV and Heart for Heart Foundation, Munich, Germany. Philips Healthcare Nederland BV, Eindhoven, The Netherlands, provided the 3-dimensional echocardiography.

PII: S0022-5223(09)00345-6

doi:10.1016/j.jtcvs.2009.02.014

The Journal of Thoracic and Cardiovascular Surgery
Volume 138, Issue 2 , Pages 365-373, August 2009

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