Impact of subxiphoid video pericardioscopy with a rigid shaft on cardiac hemodynamics in a porcine model

Objective: Single-port subxiphoid videopericardioscopy with a rigid shaft is useful for left atrial exclusion, left ventricular (LV) pacing lead implantation, and epicardial mapping, but it may interfere with the cardiac rhythm and adversely alter hemodynamics. We examined the impact of this technique on hemodynamic indices in a porcine model. Methods: The videopericardioscopy device was introduced into the pericardial space of five pigs (35-45 kg) via a subxiphoid approach and navigated to six anatomic targets [right atrial appendage, superior vena cava, ascending aorta, left atrial appendage (anterior and posterior approaches), transverse sinus, and atrioventricular (AV) groove]. After successful target acquisition, the device was withdrawn through the subxiphoid port. When the hemodynamics stabilized, the device was navigated to another target. The heart rate (HR), arterial blood pressure (BP), central venous pressure (CVP), pulmonary arterial pressure, and mixed venous oxygen saturation (SvO2) were measured at every pretarget (subxiphoid incision) and target point. After the navigation trials, the animals were killed and the mediastinum space was examined for procedure-related injuries. Results: The device afforded a good view, and the navigation trials were successfully performed on the beating heart. Four animals tolerated the procedures, whereas one died of device-induced ventricular fibrillation after the trials. Hemodynamics was severely compromised at all anatomic targets except the left atrial appendage (anterior approach). Conclusions: Subxiphoid videopericardioscopy significantly interferes with the cardiac rhythm, causing life-threatening arrhythmia and hemodynamic compromise, when the target is located deep and far from the pericardiotomy. A flexible or highly articulated device would enable intrapericardial navigation without hemodynamic compromise. © 2010 by the International Society for Minimally Invasive Cardiothoracic Surgery.