Robot-assisted real-time magnetic resonance image-guided transcatheter aortic valve replacement.
Robot-assisted real-time magnetic resonance image-guided transcatheter aortic valve replacement.
复制标题
机器人辅助实时磁共振图像引导的经导管主动脉瓣更换。
DOI：
10.1016/j.jtcvs.2015.11.047
复制
发表时间：
2016-05
期刊：
影响因子：
--
通讯作者：
Horvath KA
中科院分区：
文献类型：
--
作者：
Miller JG;Li M;Mazilu D;Hunt T;Horvath KA
实时磁共振成像(RtMRI)引导的经导管主动脉瓣置换术(TAVR)提高了可视化、实时成像和设备交付的精确度。不幸的是，由于有限的空间和笨拙的工作环境，在MRI扫描仪中执行TAVR可能是一项困难的任务。我们的解决方案是设计一种与MRI兼容的机器人辅助设备，以便从远程计算机控制台插入和展开自我扩展的瓣膜。我们在一个猪模型中展示了我们的初步结果。我们使用了一个与MRI兼容的机械臂，并开发了一个瓣膜输送模块。经剑下入路将12 mm套管针插入心尖部。机器人上安装了输送装置和镍钛合金支架假体。两个连续的实时成像平面提供了虚拟实时3D重建。外科医生通过图形用户界面远程展开瓣膜。在一项急性非存活研究中，8头猪接受了机器人辅助的rtMRI TAVR以评估其可行性。设备部署花费了61+/−5秒。部署后进行尸检，以确认成像与实际瓣膜位置之间的相关性。这些结果证明了利用rtMRI引导的机器人辅助TAVR的可行性。这种方法可以消除在MRI扫描仪内工作时进行手术的一些挑战，并可能提高TAVR的成功率。它在插入过程中提供卓越的可视化，精确地展开，并潜在地在成像设备和机器人模块之间进行通信，从而防止错误或未对齐的展开。
Real-time magnetic resonance image (rtMRI) guided transcatheter aortic valve replacement (TAVR) has improved visualization, real time imaging, and pinpoint accuracy with device delivery. Unfortunately, performing a TAVR in a MRI scanner can be a difficult task due to limited space and an awkward working environment. Our solution was to design a MRI compatible robot-assisted device to insert and deploy a self-expanding valve from a remote computer console. We present our preliminary results in a swine model. We used an MRI compatible robotic arm and developed a valve delivery module. A 12mm trocar was inserted in the apex of the heart via a subxiphoid incision. The delivery device and nitinol stented prosthesis were mounted on the robot. Two continuous real time imaging planes provided a virtual real time 3D reconstruction. The valve was remotely deployed by the surgeon via a graphic user interface. In an acute, non-survival study, eight swine underwent robot-assisted rtMRI TAVR for evaluation of feasibility. Device deployment took 61 +/− 5 seconds. Post-deployment necropsy was performed to confirm correlation between imaging and the actual valve position. These results demonstrate the feasibility of robotic assisted TAVR using rtMRI guidance. This approach may eliminate some of the challenges of performing a procedure while working inside of an MRI scanner and may improve the success of TAVR. It provides superior visualization during the insertion process, deployment with pinpoint accuracy, and potentially communication between the imaging device and the robotic module which will prevent incorrect or misaligned deployment.