MRI Guided Robotic Cardiac Surgery

MRI 引导机器人心脏手术

• 批准号: 7735010
• 负责人: Keith A Horvath
• 金额: $ 36.6万
• 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/7735010
• 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膜的主要限制是详细的可视化和耐用的假体。这项研究调查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。磁共振成像被用来精确地识别关键的解剖标志。术中补充血流灌注、血流速度和功能成像以确认瓣膜放置和功能的充分性。 在实时MR成像下，规定了多个斜面。通过使用有源(即接收无环天线的MR信号)标记线进行增强，这种成像可以正确地放置和定位人工瓣膜。经心尖入路植入一系列生物瓣(直径21~25 mm)。套管针放置后至瓣膜展开的植入时间少于90秒(77±12)秒。除了解剖证实人工瓣膜相对于主动脉环和冠状动脉的适当位置外，还通过磁共振成像获得瓣膜和左心室的功能确认。术中首次通过血流灌注扫描证实瓣膜置入后心肌血流量充足。相速度证实人工瓣叶充分开放，无瓣膜或瓣旁返流。 实时磁共振成像提供出色的解剖细节和术中评估，允许将耐用的瓣膜假体放置在跳动的心脏上，而不受经皮途径的限制。 我们目前允许动物从这些程序中恢复，并长期跟踪评估该技术的持久性。此外，我们已经开始使用MR兼容的机械臂来扩展外科医生的能力。

项目成果

Transapical sutureless aortic valve implantation under magnetic resonance imaging guidance: Acute and short-term results.

磁共振成像引导下经心尖无缝合主动脉瓣植入：急性和短期结果。

• DOI: 10.1016/j.jtcvs.2014.10.101
• 发表时间: 2015
• 期刊: The Journal of thoracic and cardiovascular surgery
• 作者: Horvath,KeithA;Mazilu,Dumitru;Cai,Junfeng;Kindzelski,Bogdan;Li,Ming
• 通讯作者: Li,Ming

Robotic system for transapical aortic valve replacement with MRI guidance.

MRI 引导下经心尖主动脉瓣置换的机器人系统。

• DOI: 10.1007/978-3-540-85990-1_57
• 发表时间: 2008
• 期刊: Medical image computing and computer-assisted intervention : MICCAI ... International Conference on Medical Image Computing and Computer-Assisted Intervention
• 作者: Li,Ming;Mazilu,Dumitru;Horvath,KeithA
• 通讯作者: Horvath,KeithA

Midterm results of transapical aortic valve replacement via real-time magnetic resonance imaging guidance.

• DOI: 10.1016/j.jtcvs.2009.08.005
• 发表时间: 2010-02
• 期刊: JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY
• 影响因子: 6
• 作者: Horvath, Keith A.;Mazilu, Dumitru;Guttman, Michael;Zetts, Arthur;Hunt, Timothy;Li, Ming
• 通讯作者: Li, Ming

Real-time magnetic resonance imaging-guided transcatheter aortic valve replacement.

• DOI: 10.1016/j.jtcvs.2015.11.024
• 发表时间: 2016-05
• 期刊: The Journal of thoracic and cardiovascular surgery
• 作者: Miller JG;Li M;Mazilu D;Hunt T;Horvath KA
• 通讯作者: Horvath KA

MRI-compatible Hands-on Cooperative Control of a Pneumatically Actuated Robot.

• DOI: 10.1109/robot.2009.5152541
• 发表时间: 2009-07-06
• 期刊: IEEE International Conference on Robotics and Automation : ICRA : [proceedings]. IEEE International Conference on Robotics and Automation
• 作者: Kapoor A;Wood B;Mazilu D;Horvath KA;Li M
• 通讯作者: Li M