Key result
A right-sided thoracotomy in sheep provided good visualization of the tricuspid valve complex but poor access to the ascending aorta, necessitating peripheral arterial cannulation.
Right thoracotomy with peripheral arterial cannulation is the optimal surgical approach for tricuspid valve interventions in sheep models.
Informs optimal surgical access for tricuspid studies in sheep; leaves open translation to other models or humans.
In quadrupeds, the three-dimensional orientation of the heart with respect to the thorax is fundamentally different from that in humans.In this study, we assessed the best surgical approach to the tricuspid valve in sheep.Firstly, different surgical access sites to the tricuspid valve were tested in sheep cadavers, the anatomy was analyzed, and the optimal surgical approach to the tricuspid valve was determined.Secondlyalong with cardiopulmonary bypass and cardioplegic arrest -the chosen approach was tested in six adult sheep in vivo.Anatomical analyses revealed that a left thoracotomy provided optimal access to the aorta and left heart.However, visualization of the right heart was significantly impaired.In contrast, a right thoracotomy provided good access to the right heart, but the ascending aorta was difficult to approach.Therefore, in the in vivo studies, arterial cannulation was performed through a carotid (n = 4) or femoral (n = 2) artery.In conclusion, a right-sided thoracotomy allows good visualization of all components of the tricuspid valve complex in sheep, but not of the ascending aorta.Consequently, peripheral vessels are preferred for arterial cannulation.This work may stimulate the investigation of pathomechanisms and/or novel treatment options for tricuspid valve pathologies.
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Bothe et al. (2017) studied Tricuspid valve surgery (n=6). Right thoracotomy vs. Left thoracotomy was evaluated on Visualization of the tricuspid valve complex and ascending aorta. A right-sided thoracotomy in sheep provided good visualization of the tricuspid valve complex but poor access to the ascending aorta, necessitating peripheral arterial cannulation.
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