Researchers at Children’s National Health System in Washington DC have developed a miniaturised prototype pacemaker that could lead to less invasive surgeries for infants.
Measuring about 1cm2, the device could be delivered using a small 1cm incision, removing the need for lengthy and traumatic open heart surgeries. Paediatric open-heart surgery can take up to several hours, depending on the child’s medical complexities. In the study, which will be presented at the American Heart Association’s Scientific Sessions 2018, the prototype was tested on piglets. It was found that the median time from incision to attaching the pacemaker was 25 minutes.
“Placing a pacemaker in a small child is different than operating on an adult, due to their small chest cavity and narrow blood vessels,” said lead author Dr Rohan Kumthekar, a cardiology fellow at Children’s National. “By eliminating the need to cut through the sternum or the ribs and fully open the chest to implant a pacemaker, the current model, we can cut down on surgical time and help alleviate pain.”
The speed of the procedure is facilitated by a patented two-channel, self-anchoring access port, previously developed by Dr Charles Berul’s bioengineering lab at Children’s National. This port hosts a camera in one channel, while first a sheath and then the pacemaker’s lead pass through the other channel. Once the lead is attached to the heart, the pacemaker itself is inserted into the incision, which is then closed up. Rather than two large suture lines, the patient is left with just a tiny scar.
“As cardiologists and paediatric surgeons, our goal is to put a child’s health and comfort first,” said Kumthekar. “Advancements in surgical fields are tending toward procedures that are less and less invasive. There are many laparoscopic surgeries in adults and children that used to be open surgeries, such as appendix and gallbladder removals. However, placing pacemaker leads on infants’ hearts has always been an open surgery. We are trying to bring those surgical advances into our field of paediatric cardiology to benefit our patients.”