a-chronic-cardiac-ischemia-model-in-swine-using-an-ameroid-constrictor

A Chronic Cardiac Ischemia Model in Swine Using an Ameroid Constrictor

Cardiovascular disease remains the number one cause of mortality in the United States. There are numerous approaches to treating these diseases, but ...

National Institutes of Health

Minimally invasive cardiac surgery requires arresting and emptying of the heart, which compromises visualization of the surgical field. In this feasibility study a novel surgical procedure is demonstrated in which real-time MRI is used to guide the placement of a prosthetic aortic valve in the beating heart via direct apical access in eight porcine hearts. A clinical stentless bioprosthetic valve affixed to a platinum stent was compressed onto a balloon-tipped catheter. This was fed through a 15-18-mm delivery port inserted into the left ventricular (LV) apex via a minimally invasive subxyphoid incision. Using interactive real-time MRI, the surgeon implanted the prosthetic valve in the correct location at the aortic annulus within 90 s. In four of the animals immediately after implantation, ventricular function, blood flow through the valve, and myocardial perfusion were evaluated with MRI. MRI-guided beating-heart surgery may provide patients with a less morbid and more durable solution to structural heart disease.

Real-time interactive MRI-guided cardiac surgery: aortic valve replacement using a direct apical approach.

: The principal limitations of percutaneous techniques to replace the aortic valve are detailed visualization and durable prostheses. We report the feasibility of using real-time magnetic resonance imaging (MRI) to provide precise anatomic detail and visual feedback to implant a proven bioprosthesis.

Beating heart aortic valve replacement using real-time MRI guidance.

Cardiovascular magnetic resonance (CMR) imaging can measure the myocardial area at risk (AAR), but the technique has received criticism for inadequate validation. CMR commonly depicts an AAR that is wider than the infarct, which in turn would require a lateral perfusion gradient within the AAR. We investigated the presence of a lateral perfusion gradient within the AAR and validated CMR measures of AAR against three independent reference standards of high quality.

Article	Year
Real-time interactive MRI-guided cardiac surgery: aortic valve replacement using a direct apical approach. Magnetic resonance in medicine\| PubMed ID: 17036300	2006
Beating heart aortic valve replacement using real-time MRI guidance. Innovations (Philadelphia, Pa.)\| PubMed ID: 22436922	2007
Temporal and spatial characteristics of the area at risk investigated using computed tomography and T1-weighted magnetic resonance imaging. European heart journal cardiovascular Imaging\| PubMed ID: 25881901	2015

Shawn Kozlov

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