Cardioscopy: potential applications and benefit in cardiac surgery

Objective: Cardioscopy in open heart surgery is still not routine in most units. However, since our first report in 1996 we use this device more frequently, because we think that safety and accuracy of different surgical procedures is increased. Methods: Between 1/96 and 12/97 we performed cardioscopy in 100 patients. Indications (IND) for cardioscopy were as follows: IND (1) resection of hypertrophied septum (N=15); IND (2) evaluation of aortic valve with low grade stenosis or insufficiency (N=12); IND (3) removal of intracardiac foreign bodies/tumors (N=13); IND (4) inspection of VSD prior and after repair (N=8); IND (5) identification of paravalvular leakage (N=8); IND (6) diagnostic purposes (N=4); IND (7) education of surgeons and operating room staff (N=40).During cardioplegic arrest the 5 mm rigid or flexible cardioscope (Storz®, Tuttlingen, Germany) was inserted through ascending aorta, aortic valve or tricuspid valve depending on indication. Results: No complication occurred during cardioscopy. IND (1): there was an excellent view of all intracardiac structures. Thorough resection of hypertrophied septum was possible and there was no injury of adjacent structures or aortic valve. IND (2): all valves were inspected through a 1 cm aortic incision and the pathology of the valves was documented. In case of severe calcification, the valve was replaced although transvalvular gradient was less than 50 mm Hg. IND (3): intraventricular foreign bodies, such as felt pledges (N=2), debris (N=5), thrombi (N=4) and tumors (N=2) were entirely removed through the aortic valve with a special forceps. IND (4): anatomy of VSD was documented in all cases. It was possible to test accuracy of all patch-sutures. IND (5): all paravalvular leakages were identified eventhough there was heavy immobility of the mechanical valve. IND (6): a papillary muscle (N=2) and a thrombus formation (N=2) were diagnosed. IND (7): the surgeons and operating room staff could follow the entire procedure in all cases. Conclusions: Cardioscopy is a supporting technique to clearly identify intracardiac structures, to control several surgical procedures, to document valve pathology, and to educate surgeons and operating room staff. Handling is easy and does not increase operative risk. Some procedures will be performed with minimal invasivity in future.