Abstract Body (Do not enter title and authors here): Background: Intrapericardial delivery of antiarrhythmic drugs and regenerative therapies is a growing field for infants and children who suffer from certain cardiac diseases. Typically, this is performed under fluoroscopic and/or ultrasonic guidance. Pericardial access via thoracoscopy provides direct visualization of the heart, enabling the operator to avoid injuries to critical cardiac structures, and to visualize intrapericardial injections for targeted drug therapies.

Objective: To demonstrate the feasibility of minimally-invasive intrapericardial injections under direct visualization using a novel thoracic access port in immature swine.

Methods: Minimally-invasive procedures were performed in 12 Sinclair piglets (8 at 1-month old, 4.1 ± 1.5 kg; 4 at 5-months old, 26.3 ± 1.0 kg). A single 1.2 cm incision just to the left of the subxiphoid process allowed for temporary insertion of the thoracic access port. An EndoCAMeleon thoracoscope with active insufflation was used to visualize the thoracic cavity and the heart (pericardium). An 18-gauge needle was used to gain access to the intrapericardial space. Saline or dyed saline was injected through the needle and/or sheath with direct visualization and confirmed on the thoracoscope. Following the procedure, the access tool was removed and the incision was sutured closed. All studies were performed under IACUC approval.

Results: Minimally-invasive intrapericardial injections were successfully performed in 8 infant- and 4 child-sized swine with real-time visualization (Figure). The average time between the incision and pericardial needle access was 16.8 ± 5.0 minutes. No adverse events were observed from either the intrapericardial fluid injection or the use of the thoracic access tool.

Conclusion: We demonstrated the feasibility and safety of minimally-invasive intrapericardial injections under direct visualization in swine using a novel thoracic access port. Direct targeted pericardial injection of medications or gene therapies can be performed using this technique. This approach holds promise for providing an alternative to cardiac restoration in infant and pediatric patients who are not amenable to traditional therapies.