CorAccess: Strengthening Heart Tissue

CorAccess: Strengthening Heart Tissue and Port Access for Cardiac Surgery

Minimally invasive heart valve replacement procedures have emerged as an alternative to open-chest heart surgery, allowing smaller incisions, less pain, and faster recovery. Transapical cardiac access is one such procedure where the inner chambers of the heart are accessed by puncturing a hole in the apex of the heart. Catheters are inserted into the heart through this port, and devices such as heart valves are delivered through them. This technique is already used clinically, to implant heart valves, connect artificial hearts, etc. but a frequent problem is the poor mechanical strength of the tissue in this region.

Robert Guyton MD
Robert Guyton, MD

Researchers at Emory have developed a method that strengthens the tissue of the heart apex to increase stability, prevent leakage, and provide a sound channel to the cardiac chambers that can be securely closed after the procedure. "Not all hearts are the same, as far as the mechanical strength of the tissue—in the elderly, or those who don't exercise and have fatty tissues, the tissue is quite weak and normal closure devices like sutures, clamps, screw devices, will not hold," says Robert Guyton, MD, chief of cardiothoracic surgery at Emory University Hospital who, along with Muralidhar Padala, PhD, assistant professor in the Division of Cardiothoracic Surgery, invented the device.

CorAccess technology includes: devices that strengthen the tissues of the heart by heating the tissue around the access channel, a port anchored firmly in the access channel, and a plug that can be implanted to close the port after the procedure. "This doesn’t seem to damage the heart, cardiac function is preserved and it doesn’t cause heart arrhythmias," says Guyton. "It seems a safe way to gain access with simple technique."

Muralidhar Padala, PhD
Muralidhar Padala, MD

Entering through the chest wall directly into the heart apex also streamlines the surgery. "If we can access the tip of the heart by puncturing the skin of the chest and putting a cannula, an open tube, into the tip of heart, then we could operate only an inch and a half away from the skin of the chest," Guyton says. "If we approach through the leg/groin, a foot and a half away, that’s a tortuous route through which catheters must be placed."

The CorAccess technology has been tested in large animal models but is awaiting human clinical trials. Eventually, Guyton says, more than half of all patients who currently have heart valve surgery could be candidates for this device, which is more than 100,000 patients annually in the US alone.

"This unique approach that these investigators have devised is a great example of innovating outside of the box," says Cale Lennon, director of licensing for Emory's Office of Technology Transfer. "This technique enables heart surgeons to operate more safely and effectively on the sickest of patients who can most benefit from these minimally invasive techniques."

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