MRI Guided Robotic Cardiac Surgery

MRI 引导机器人心脏手术

• 批准号: 7594430
• 负责人: Keith A Horvath
• 金额: $ 67.78万
• 依托单位: NATIONAL HEART, LUNG, AND BLOOD INSTITUTE
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/7594430
• 关键词: Anatomy; Animals; Bioprosthesis device; Blood flow; Cardiac Surgery procedures; Cardiopulmonary Bypass; Compatible; Coronary artery; Family suidae; Functional Imaging; Heart; Image; Imagery; Implant; Intervention; Invasive; Left ventricular structure; Magnetic Resonance Imaging; Modification; Myocardial; Operative Surgical Procedures; Patients; Perfusion; Phase; Placement; Procedures; Prosthesis; Pump; Robotics; Scanning; Series; Signal Transduction; Surgeon; Surgical incisions; Sus scrofa; Techniques; Time; Trauma; Trocars; Upper arm; aortic valve; implantation; visual feedback

The principal limitations of percutaneous techniques to replace the aortic valve principal are detailed visualization and durable prostheses. This study investigated the use of real-time magnetic resonance imaging to provide precise anatomic detail and visual feedback to implant a proven bioprosthesis. Via a minimally invasive approach using real-time MRI guidance 22 pigs underwent off-pump aortic valve replacement. MR imaging was used to precisely identify critical anatomic landmarks. Additional intraoperative perfusion, flow velocity and functional imaging were used to confirm adequacy of placement and function of the valve. Under real-time MR imaging, multiple oblique planes were prescribed. Enhanced by the use of an active (i.e. MR signal receiving loopless antennae) marker wire, this imaging allowed correct placement and orientation of the prosthetic valve. Via a transapical approach a series of bioprosthetic aortic valves (21-25mm) were inserted. The time to implantation after the placement of the trocar to deployment of the valve was less than ninety seconds (77 + 12). In addition to anatomic confirmation of adequate placement of the prosthetic valve in relation to the aortic annulus and the coronary arteries, functional confirmation of the valve and left ventricle was also obtained with MR imaging. Intraoperative first pass perfusion scanning documented adequacy of myocardial blood flow after valve placement. Phase velocity confirmed adequate opening of the prosthetic valve leaflets and lack of valvular or paravalvular regurgitation. Real-time MR imaging provides excellent anatomic detail and intraoperative assessment that permits placement of durable valve prostheses on the beating heart without the limitations of percutaneous approaches. We are presently allowing animals to recover from these procedures and following them long term to assess the durability of the technique. Additionally we have started to employ MR compatible robotic arms to extend the surgeons' capability.

经皮技术取代主动脉瓣主的主要局限性是详细的可视化和耐用的假体。 这项研究研究了实时磁共振成像的使用，以提供精确的解剖细节和视觉反馈，以植入经过验证的生物植物。 通过使用实时MRI指南的微创方法，22头猪进行了非泵主动脉瓣置换。 MR成像用于精确识别关键的解剖标志。使用其他术中灌注，流速和功能成像来确认阀门的放置和功能的充分性。 在实时MR成像下，开了多个斜面。 通过使用活性（即接收无环形天线）标记线的活性增强，此成像允许正确放置和定向假体阀。通过跨速方法，插入了一系列生物假体主动脉瓣（21-25mm）。 放置套管下植入后植入的时间小于90秒（77 + 12）。 除了解剖学确认与主动脉环和冠状动脉相关的假体瓣膜适当放置外，还通过MR成像获得了瓣膜和左心室的功能确认。 术中首次通过灌注扫描记录了瓣膜放置后心肌流动的充分性。 相速度证实了假体瓣膜传单的足够开口以及缺乏瓣膜或旁腔的反流。 实时MR成像提供了出色的解剖细节和术中评估，可以将耐用的瓣膜假体放置在跳动的心脏上，而无需经皮方法的局限性。 目前，我们允许动物从这些程序中恢复，并长期遵循它们以评估技术的持久性。此外，我们已经开始使用MR兼容的机器人臂来扩展外科医生的能力。