Midterm results of transapical aortic valve replacement via real-time magnetic resonance imaging guidance.
Midterm results of transapical aortic valve replacement via real-time magnetic resonance imaging guidance.
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DOI：
10.1016/j.jtcvs.2009.08.005
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发表时间：
2010-02
影响因子：
6
通讯作者：
Li, Ming
中科院分区：
文献类型：
--
作者：
Horvath, Keith A.;Mazilu, Dumitru;Guttman, Michael;Zetts, Arthur;Hunt, Timothy;Li, Ming
经皮瓣膜置换术目前正在临床试验中进行评估。由于瓣膜的输送是基于导管的，这些程序的安全性和有效性可能会受到所采用的成像的影响。为了帮助操作者并提高手术的成功率，我们采用实时MRI引导（rtMRI）进行了经根尖主动脉瓣置换术（AVR）。28头猪对跳动的心脏进行了磁共振AVR检查。使用无支架生物假体安装在可膨胀的球囊支架上。采用1.5T磁共振成像识别关键解剖标志。除了解剖证实假体的适当放置外，还通过MRI评估瓣膜和左心室的功能和灌注。进行了一系列急性可行性实验（n=18），动物在瓣膜放置和MRI评估后死亡。另外10只动物被允许存活，并在术后1、3和6个月随访MRI扫描和确认性超声心动图。rtMRI提供了所需地标的优越可视化。根尖通路后种植时间为74±18秒。灌注扫描显示冠状动脉血流充足，在所有动物成功部署后，功能成像记录了心室收缩性的保存。相衬成像显示极少瓣膜内或瓣旁渗漏。长期结果表明，随着时间的推移，植入物的稳定性与心肌灌注和功能的保存。rtMRI为术中AVR对跳动心脏的指导提供了良好的可视化。此外，它还可以评估组织灌注和器官功能，这是常规成像无法获得的。
Percutaneous valve replacements are presently being evaluated in clinical trials. As delivery of the valve is catheter based, the safety and efficacy of these procedures may be influenced by the imaging employed. To assist the operator and improve the success of the operation, we have performed transapical aortic valve replacements (AVR) using real-time MRI guidance (rtMRI). 28 swine underwent rtMRI AVR on the beating heart. Stentless bioprostheses mounted on balloon-expandable stents was used. MR imaging (1.5T) was used to identify the critical anatomic landmarks. In addition to anatomic confirmation of adequate placement of the prosthesis, functional assessment of the valve and left ventricle and perfusion was also obtained with MRI. A series of acute feasibility experiments were conducted (n=18) in which the animals were sacrificed after valve placement and MRI assessment. Ten additional animals were allowed to survive and had follow-up MRI scans and confirmatory echocardiography at 1, 3, and 6 months postoperatively. rtMRI provided superior visualization of the landmarks needed. The time to implantation after apical access was 74±18 seconds. Perfusion scanning demonstrated adequate coronary flow and functional imaging documented preservation of ventricular contractility in all animals following successful deployment. Phase contrast imaging revealed minimal intra or para-valvular leaks. Longer term results demonstrated stability of the implants with preservation of myocardial perfusion and function over time. rtMRI provides excellent visualization for intraoperative guidance of AVR on the beating heart. Additionally it allows assessment of tissue perfusion and organ function that are not obtainable by conventional imaging alone.
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影响因子：
3.3
作者：
Guttman, MA;Kellman, P;McVeigh, ER
通讯作者：
McVeigh, ER
影响因子：
3.4
作者：
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影响因子：
37.8
作者：
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影响因子：
37.8
作者：
Boudjemline, Y;Bonhoeffer, P
通讯作者：
Bonhoeffer, P
影响因子：
3.3
作者：
Kellman, P;Derbyshire, JA;Arai, AE
通讯作者：
Arai, AE