KR20060030074A - Percutaneous endoscopic epicardial procedure - Google Patents

Abstract

Percutaneous (incision) epidural procedure with cardiac endoscopy

{Percutaneous Endoscopic Epicardial Procedure}

Various surgical treatments have been developed for the treatment of heart disease. However, when the treatment is performed on the epicardium side through the pericardium of the heart, it is difficult to incision the sternum (thoracic bone). However, if the endoscope can be inserted into the pericardium by injection after local anesthesia, the procedure can be performed through various epicardium in a good field of view without general anesthesia or sternal incision.

As such, the invention of percutaneous cardiac endoscopy (no need for incision through the needle through the skin) enables minimally invasive cardiac surgery, arrhythmia surgery, cell therapy for heart failure, local epicardial drug delivery, Maximize the efficiency of biventricular cardiac pacemaker procedures.

Endoscopic cardiac, epicardium, arrhythmia, cell therapy

Description

Percutaneous Endoscopic Epicardial Procedure using Heart Endoscopy

Fig. 1.Zoom in with 18G Tuohy needle and 8Fr metal sheath (left) Tuohy needle for percutaneous (incision) epicardial access (right)

Figure 2. An 8Fr metal sheath insertion into the pericardial cavity (left) with a 0.035 guidewire inserted through the incision-free epicardial approach in real patients (right).

3. A scene where arrhythmia (ventricular tachycardia) radiofrequency ablation is performed with a high frequency electrode ceramic inserted into the pericardium. RAO (right anterior oblique view; right warrior); Left anterior oblique view (LAO); Endo (endocardial electrode conductor); Epi (electrocardial electrode).

4. Readiness of large animal (pig) experiments for endoscopic epicardial approach. A puncture needle, sheath, and guide wire are prepared for the next step with minimally invasive pericardium.

Fig. 5. 14Fr sheath is inserted into the pericardium (left). Endoscope is inserted through the sheath to observe the epicardium with the endoscope for the procedure (right).

6. The shape of the heart as seen from the epicardium side taken by endoscope. Left atrium-left ventricular connection (left) and right atrium right ventricle (right). It is possible to insert the electrode, cell delivery, and pacemaker electrodes into the hole for the procedure attached to the endoscope. LAA (left atrial appendage); LV lat wall (left ventricular side wall); RAA (right atrium appendage); SVC (relative vein); Fat pad (fat tissue containing parasympathetic ganglia).

Medical heart disease treatment field.

In conventional cardiac surgery, the sternum located right in front of the heart, the pericardium, the pericardium, and the approach to the epicardium were used. This requires the need for general anesthesia, extensive skin incision, and major surgery to incise the sternum. There was.

Micro-incision cardiac surgery is optionally used, but it has the disadvantage of requiring surgery in a limited field of view and it is impossible to approach the back of the heart.

Recently, new treatment procedures such as arrhythmia resection, cardiac failure cell therapy, cardiac local delivery therapy, and cardiac failure bilateral ventricular cardiac pacemaker treatment have been newly developed. It is burdensome from the therapist's point of view and at the same time there is a problem of complications or lengthy hospital stay.

The present invention seeks to 1) do not require an incision or general anesthesia 2) without limitation of field of vision 3) effectively approach the epicardium to perform a cardiac procedure.

Invention of use: Various surgical treatments have been developed for the treatment of heart disease. However, when the treatment is performed at the pericardium of the heart through the pericardium enclosing the heart, it is difficult to make a large surgery to incise the sternum. However, if the endoscope can be inserted into the pericardium by injection after local anesthesia, the procedure can be performed through various epicardium in a good field of view without general anesthesia or sternal incision.

As such, the invention of percutaneous cardiac endoscopy (no need for incision through the needle through the skin) enables minimally invasive cardiac surgery, arrhythmia surgery, cell therapy for heart failure, local epicardial drug delivery, Maximize the efficiency of biventricular cardiac pacemaker procedures.

First, for the procedure without incision and general anesthesia, a needle is inserted into the pericardium after local anesthesia to secure a passage to the epicardium (14Fr polyethylene sheath).

Second, an endoscope with an outer diameter of 23mm can be inserted into the pericardial passage to overcome the limitation of vision, allowing access to any part of the heart epicardium.

Third, various procedures can be performed on the cardiac epithelium by inserting high frequency electrode, cell or drug delivery, and pacemaker epicardial electrodes into the surgical holes attached to the endoscope for effective treatment. Because of the procedure, it is possible to do the procedure safely by avoiding dangerous parts such as blood vessels and nerves.

As such, the percutaneous (incision) epidural procedure using a cardiac endoscope can be applied to the following cardiac procedures.

Arrhythmia Surgery Using Radiofrequency Energy or Cryotherapy

2. Cell therapy for the treatment of heart failure and bradycardia arrhythmias (stem or myofibroblast transplantation)

3. Topical intrathecal delivery of cardiac drugs

4. Epicardial Fixation of Biventricular Pacemaker Electrodes for the Treatment of Heart Failure.

1. Percutaneous (incision) epicardial approach

Local anesthesia with 2% lidocaine was applied to the skin under the sternum and puncture the pericardium with an 18G Tuohy needle (Fig. 1).

After irradiation, 1 mL of contrast agent was injected into the Tuohy needle to confirm that it was inserted into the pericardial space (Fig. 2).

Insert a 0.035 guidewire into the Tuohy needle, then remove the Tuohy needle (Fig. 2 right).

Insert 14Fr polyethylene sheath along the guide wire and remove the guide wire (figure 5 left).

2. Percutaneous (incision) Endocardial Endoscopy

A fiberoptic endoscopy with an outer diameter of 23 mm was inserted through a 14 Fr polyethylene sheath (figure 5).

Endoscopy moves while identifying blood vessels and anatomical regions of the heart (Figure 6).

The location of the epicardium of the endoscope is confirmed by radiography.

The surgical hole attached to the endoscope is inserted into the cardiac epithelium with the necessary equipment or catheter inserted.

3. Endoscopic Percutaneous Arrhythmia Resection with Endoscopy

Most conventional arrhythmia resections are performed in the inner endocardium (inside), and some limited surgical procedures in the endocardium require surgical removal of the sternum.

However, no percutaneous (incision) approach to arrhythmia lesions located in the epicardium of atrial fibrillation or ventricular tachycardia has been developed.

Pericardioscopic endoscopy is performed with a radiofrequency or cryotherapy arrhythmia with a 4 ~ 5mm tip electrode catheter.

4. Endoscopic Percutaneous (incision) Epicardial Cell Therapy

Research into cell therapy (stem cells or myofibroblasts) or cardiac heartbeat replacement (biopacemaker) for patients with heart failure has been actively conducted, but it is necessary to avoid surgery and develop a less invasive cell delivery method.

Vascular delivery of cell therapy has low cell transplantation efficiency, and endocardial delivery has the risk of serious complications such as embolism, and epicardial delivery has the best efficiency and stability but requires major surgery such as sternal incision. The disadvantage is that.

Intrapericardial endoscopy confirms proper cell delivery position, and safe and efficient cell treatment is possible without incision when cells are injected by avoiding blood vessels or nerves.

Inject the catheter for cell injection into the procedure hole attached to the endoscope, and transplant the cells while observing the appropriate area that needs cell transplantation by endoscope.

5. Percutaneous (incision) Pericardial Pacemaker Electrode Fixation Using Endoscopy

New pacemaker treatments, such as biventricular tuning, have been shown to reduce mortality and hospitalization in heart failure patients.

At present, the left ventricular epicardial electrodelective technique uses a method of inserting a thin electrode through the coronary sinus and the coronary vein.

If the left ventricular epicardial electrode can be fixed while visually confirming the proper position in the epicardium, it is the safest and most efficient biventricular coordination, but this requires major surgery requiring thoracotomy.

If periendoscopic endoscopy confirms proper electrode fixation and avoids blood vessels or nerves, electrical tuning can be performed safely and efficiently.

Insert the forceps to fix the pacemaker cardiac epicardium electrode into the surgical hole attached to the endoscope, and in another percutaneous approach, insert the cardiac pacemaker electrode to fix the cardiac epicardium electrode in place.

1. The prevalence of atrial fibrillation in arrhythmia accounts for 1.5% of the total population and 5% of elderly people over 65 years old. In particular, the risk of complications of ischemic stroke is 6-10% per year.

2. In paroxysmal atrial fibrillation, the endocardial procedure is more than 85% successful, but in case of persistent atrial fibrillation, which accounts for most of the actual atrial fibrillation, the endocardial procedure is only 60% successful.

3. Arrhythmia resection without or without minimal incision through the epicardium is expected to significantly improve the success rate for persistent atrial fibrillation with minimal complications.

4. The prevalence of heart failure is 2% of the population and 10% of the elderly aged 75 or older.

5. The prevalence of heart failure has increased by 165% over the last 20 years. It is expected to reach 8% of the population by 2040.

6. Stem cell transplantation therapy has been limited to ischemic heart failure, but it is expected to be expanded to non-ischemic heart failure in the future.

7. It would be desirable to develop a less invasive and less selective cell therapy regimen with an intracardiac approach, which was only available during open heart surgery.

8. Bilateral ventricular electrocoordination using pacemakers has been established as an effective treatment for heart failure, and safer and more effective treatment effect is expected by simultaneously performing biventricular electrocoordination and cell therapy.

9. Through the results of the present invention 1. Improved success rate of arrhythmia resection of persistent atrial fibrillation, 2. Development of cardiac failure and bradycardia arrhythmia treatment using epicardial cell therapy, 3. Development of intracardiac local delivery therapy of cardiac drugs, 4. The development of epicardial biventricular tuning for heart failure patients is expected to be possible.

Claims (1)

4.1 Claim 1 Arrhythmia Surgery with Endoscopic Percutaneous (without Incision) Epicardial Approach 4.2 Claim 2: Cell Therapy Therapy with Percutaneous (incision) Epicardial Approach Using Endoscopy     4.3 Claim 3: Topical pharmacovigilance with percutaneous (no incision) epicardial approach using endoscopy                              Moon therapy     4.4 Claim 4: Cardiac pacemaker cardiac with percutaneous (no incision) epicardial approach using endoscopy Outer membrane electrode fixation

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