Open Access Research article

The effectiveness of rigid pericardial endoscopy for minimally invasive minor surgeries: cell transplantation, epicardial pacemaker lead implantation, and epicardial ablation

Takehiro Kimura1*, Shunichiro Miyoshi1, Kazuma Okamoto2, Kotaro Fukumoto1, Kojiro Tanimoto1, Kyoko Soejima3, Seiji Takatsuki1 and Keiichi Fukuda1

Author Affiliations

1 Department of Cardiology, Keio University School of Medicine, Tokyo, Japan

2 Department of Cardiovascular surgery, Keio University School of Medicine, Tokyo, Japan

3 Department of Cardiology, Kyorin University Hospital, Tokyo, Japan

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Journal of Cardiothoracic Surgery 2012, 7:117  doi:10.1186/1749-8090-7-117

Published: 9 November 2012

Abstract

Background

The efficacy and safety of rigid pericardial endoscopy as the promising minimally invasive approach to the pericardial space was evaluated. Techniques for cell transplantation, epicardial pacemaker lead implantation, and epicardial ablation were developed.

Methods

Two swine and 5 canines were studied to evaluate the safety and efficacy of rigid pericardial endoscopy. After a double pericardiocentesis, a transurethral rigid endoscope was inserted into the pericardial space. The technique to obtain a clear visual field was examined, and acute complications such as hemodynamic changes and the effects on intra-pericardial pressure were evaluated. Using custom-made needles, pacemaker leads, and forceps, the applications for cell transplantation, epicardial pacemaker lead implantation, and epicardial ablation were also evaluated.

Results

The use of air, the detention of a stiff guide wire in the pericardial space, and the stretching of the pericardium with the rigid endoscope were all useful to obtain a clear visual field. A side-lying position also aided observation of the posterior side of the heart. As a cell transplantation methodology, we developed an ultrasonography-guided needle, which allows for the safe visualization of transplantation without major complications. Pacemaker leads were safely and properly implanted, which provides a better outcome for cardiac resynchronizing therapy. Furthermore, the success of clear visualization of the pulmonary veins enabled us to perform epicardial ablation.

Conclusions

Rigid pericardial endoscopy holds promise as a safe method for minimally invasive cell transplantation, epicardial pacemaker lead implantation, and epicardial ablation by allowing clear visualization of the pericardial space.

Keywords:
Rigid pericardial endoscopy; Minimally invasive surgery; Cell transplantation; Epicardial pacemaker lead implantation; Epicardial ablation