Abstract
Ventricular outflow obstruction in the infant remains a surgical challenge with high operative mortality despite a variety of approaches. An apical to aortic conduit would be a direct approach but usually required cardiopulmonary bypass and removal or fixation of perhaps a critical amount of apical myocardium. Therefore, we developed a two component apical prosthesis consisting of a grommet, fixed internally by a flange, that can be placed via the atrium without bypass and an external female adapter. This transatrial ventricular access device (TAVAD) does not require removal of myocardial tissue or sutures. The TAVAD concept was acutely tested in 8 anesthesized dogs (mean wt. = 15 kg). Initially the TAVAD device was capped and acute stability in the myocardium was demonstrated in 5 dogs. Subsequently, in 3 dogs, the TAVAD method was used to achieve communication with a valved conduit to the thoracic aorta. Acute grommet stability in the myocardium was evident even with the conduit attached and ventricular pressures up to 250 mmHg. The ability to carry cardiac output was demonstrated by ascending aortic occlusion. Chronic implantation off bypass in 3 lambs (mean wt, = 8.5 kg) has shown continued myocardial fixation and conduit function. Angiography demonstrated unobstructed apical to aortic flow and normal ventricular wall motion. Since the lamb myocardium is similar in thickness to the human infant, we conclude that the TAVAD device and method may be useful in relieving ventricular outflow obstuction in infants while preserving myocardial tissue and function.
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Boucek, M., Chang, R. & McGough, E. EXPERIMENTAL USE OF A NEW ATRIALLY PASSED, SUTURELESS, VENTRICULAR APEX TO AORTA CONDUIT. Pediatr Res 21 (Suppl 4), 187 (1987). https://doi.org/10.1203/00006450-198704010-00126
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DOI: https://doi.org/10.1203/00006450-198704010-00126