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A Novel Treatment Using an Intraventricular Stent Graft for Postinfarction Ventricular Septal Rupture in a Porcine Model

Nishida, Yuji MD; Tomita, Shigeyuki MD, PhD; Kiuchi, Ryuta MD, PhD; Ohtake, Hiroshi MD, PhD; Watanabe, Go MD, PhD

Innovations:Technology and Techniques in Cardiothoracic and Vascular Surgery: January/February 2017 - Volume 12 - Issue 1 - p 21–27
doi: 10.1097/IMI.0000000000000333
Original Articles

Objective Ventricular septal rupture (VSR) is a severe complication of acute myocardial infarction, and the conventional technique for repair is associated with high operative mortality. A novel intraventricular stent graft (IVSG) device was tested as a less invasive treatment for VSR; it does not require cardiopulmonary bypass, cardiac arrest, or left ventricular incision. Its effectiveness was assessed using animal experiments.

Methods Six pigs were placed on cardiopulmonary bypass. The VSR model was created by making a hole in the interventricular septum via the right ventricle. Animals were weaned off the bypass. The sheath encasing the device was advanced over the guidewire, and the IVSG was placed in the left ventricle. Before and after rupture creation and after device deployment, left ventriculography was performed, hemodynamic data were collected, and Qp/Qs values were measured.

Results All procedures were completed safely. The left-to-right shunt seen after rupture creation disappeared after device deployment. The pulmonary-to-systemic blood flow ratio after rupture was 3.35 ± 1.00, decreasing significantly to 1.09 ± 0.10 after device deployment (P = 0.007). Hemodynamic instability after rupture creation improved dramatically after deployment.

Conclusions The use of our new IVSG in this VSR animal experiment model significantly decreased the left-to-right shunt. The new device was able to control the acute heart failure associated with VSR with a minimally invasive procedure during the hyperacute phase of heart failure. Potential improvements in VSR treatment outcomes are expected with its clinical application.

From the Department of General and Cardiothoracic Surgery, Kanazawa University, Kanazawa, Japan.

Accepted for publication December 2, 2016.

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Disclosure: The authors declare no conflicts of interest.

Address correspondence and reprint requests to Yuji Nishida, MD, Departments of General and Cardiothoracic Surgery, Kanazawa University, Takara-machi 13-1, Kanazawa 920-8641, Japan. E-mail: yu-ji@umin.net.

©2017 by the International Society for Minimally Invasive Cardiothoracic Surgery