Key result
Transcatheter cavocaval connection proves safe and feasible in 11 surviving chronic sheep.
Why the study?
The safety and feasibility of transcatheter techniques for cavocaval connection to complete Fontan circulation in chronic animal models were not established.
Are transcatheter techniques for intracardiac and extracardiac cavocaval connection safe and feasible for Fontan completion in chronic ovine models?
Are transcatheter techniques for intracardiac and extracardiac cavocaval connection safe and feasible for Fontan completion in chronic ovine models?
Transcatheter completion of both intracardiac and extracardiac cavocaval connections is safe and feasible in chronic ovine models, suggesting potential application for Fontan completion.
Transcatheter Fontan completion remains preclinical; extends ovine feasibility data but leaves open human translation.
OBJECTIVES: We report the safety and feasibility of various transcatheter techniques of cavocaval connection in principle for the completion of Fontan circulation in viable, chronic and ovine heart models. Surgically simulated preparations of both intracardiac and extracardiac cavocaval connections were studied. METHODS: Sixteen sheep were divided into two groups per the type of surgical preparation. All animals underwent standard right thoracotomy with interposition of a 20-mm Gore-tex(®) conduit between the superior vena cava (SVC) and the right atrium (RA). Nitinol rings were placed around the SVC and the inferior vena cava (IVC). In Group I (intracardiac, n = 10), the SVC-RA junction was closed using a polytetrafluoroethylene (PTFE) membrane 1 cm below the SVC-Gore-tex(®) anastomosis. In Group II (extracardiac, n = 6), a 20-mm Gore-tex conduit de-aired and filled with heparinized saline was anastomosed to connect the SVC and the IVC. The IVC end was anastomosed in a termino-lateral fashion and the SVC end in a termino-terminal fashion; both the ends were occluded with a PTFE membrane. Animals were scheduled for transcatheter cavocaval connection after a variable healing period. RESULTS: Four animals in Group I died; three early and one late after surgical preparation. After a median interim period of 1 month (0-9 months), five sheep from Group I and six from Group II underwent successful transcatheter cavocaval connection. Perforation of the PTFE membrane was successful in all animals. Covered stents were deployed precisely and with good stability ensured by the nitinol rings. All animals survived transcatheter completion and were sacrificed after a median follow-up of 4 months (0-8 months) per protocol. No stent migration, thromboembolic events, residual shunts or paraprosthetic leak was noticed on angiographic evaluation or at autopsy in any animal. CONCLUSIONS: Transcatheter techniques for completion of cavocaval connection in surgically simulated, chronic animal models is safe and feasible. Both techniques were equally successful with no failures or short-term complications. Such techniques should work in principle for completion of intracardiac and extracardiac Fontan circulation.
No takes yet. Share an insight, caveat, or question.
Boudjemline et al. (2012) studied Fontan circulation completion (n=16). Transcatheter techniques for cavocaval connection vs. Intracardiac vs extracardiac surgical preparation was evaluated on Safety and feasibility of transcatheter cavocaval connection. Transcatheter techniques for completion of intracardiac and extracardiac cavocaval connection were safe and feasible in chronic sheep models, with successful completion in all 11 surviving animals.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: