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.

经皮技术替代主动脉瓣的主要局限性是详细的可视化和耐用的假体。 这项研究调查了使用实时磁共振成像来提供精确的解剖细节和视觉反馈，以植入经过验证的生物假体。 通过使用实时 MRI 引导的微创方法，22 头猪接受了非体外循环主动脉瓣置换术。 磁共振成像用于精确识别关键的解剖标志。使用额外的术中灌注、流速和功能成像来确认瓣膜的放置和功能是否充分。 在实时 MR 成像下，规定了多个倾斜平面。 通过使用有源（即 MR 信号接收无环天线）标记线增强，该成像允许正确放置和定向人工瓣膜。通过经心尖入路，插入一系列生物假体主动脉瓣（21-25mm）。 从放置套管针到部署瓣膜的植入时间不到九十秒（77 + 12）。 除了解剖学上确认人工瓣膜相对于主动脉环和冠状动脉的适当放置之外，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血流是否充足。 相速度证实人工瓣叶充分张开并且没有瓣膜或瓣周反流。 实时 MR 成像提供出色的解剖细节和术中评估，允许在跳动的心脏上放置耐用的瓣膜假体，而不受经皮方法的限制。 我们目前正在让动物从这些程序中恢复，并长期跟踪它们以评估该技术的耐久性。此外，我们已经开始采用 MR 兼容的机械臂来扩展外科医生的能力。