Laparoscopic transdiaphragmatic access to the apex of the left ventricle of the heart

Jess L. Thompson, Rakesh M. Suri, Stephen H. McKellar, Hartzell V Schaff

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Objective: Delivery of a collapsable aortic valve prosthesis via the left ventricular (LV) apex has proven problematic clinically. We describe our experience with a novel technique for a laparoscopic transdiaphragmatic approach to the LV outflow tract (LVOT). Methods: Laparoscopic transabdominal access to the left ventricle was achieved in four live swine and one human cadaver using three abdominal laparoscopic trocars. Pericardioscopy and cardioscopy were performed. A hemostatic purse-string suture was placed lapa-roscopically at the apex of the left ventricle in one pig, and an instrument passed through the purse-string and into the LVOT. After the procedure, a thoracotomy was performed and the heart explanted for gross examination. Results: Transdiaphragmatic exposure of the LV apex was accomplished at a mean of 23 minutes. Hemodynamic stability was maintained in all animals and the pleural cavities were not violated. Pericardioscopy allowed visualization of both right and left pulmonary veins along with the left atrial appendage. In situ cardioscopy confirmed that access to the LVOT and the aortic annulus was possible from the LV apex entry site. Conclusions: Laparoscopic transdiaphragmatic approach to the LVOT is a possible route for minimally invasive beating heart aortic valve implantation. This strategy permits a straight transapical line of access to the aortic valve; avoiding the potential for cardiac torsion via a thoracotomy.

Original languageEnglish (US)
Pages (from-to)27-31
Number of pages5
JournalInnovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
Volume4
Issue number1
DOIs
StatePublished - Jan 1 2009

Fingerprint

Aortic Valve
Heart Ventricles
Thoracotomy
Swine
Pleural Cavity
Atrial Appendage
Pulmonary Veins
Heart Valves
Hemostatics
Cadaver
Surgical Instruments
Sutures
Prostheses and Implants
Hemodynamics

Keywords

  • Animal model
  • Minimal access
  • Transapical
  • Valve insertion
  • Valve replacement

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Laparoscopic transdiaphragmatic access to the apex of the left ventricle of the heart. / Thompson, Jess L.; Suri, Rakesh M.; McKellar, Stephen H.; Schaff, Hartzell V.

In: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery, Vol. 4, No. 1, 01.01.2009, p. 27-31.

Research output: Contribution to journalArticle

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