title: Real-time interactive MRI-guided cardiac surgery: aortic valve replacement using a direct apical approach.
abstract: 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.
authors.affiliation: Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland 20892-1061, USA. mcveigh@nih.gov
authors.forename: Elliot R
authors.initials: ER
authors.lastname: McVeigh
authors.forename: Michael A
authors.initials: MA
authors.lastname: Guttman
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Lederman
authors.forename: Ming
authors.initials: M
authors.lastname: Li
authors.forename: Ozgur
authors.initials: O
authors.lastname: Kocaturk
authors.forename: Timothy
authors.initials: T
authors.lastname: Hunt
authors.forename: Shawn
authors.initials: S
authors.lastname: Kozlov
authors.forename: Keith A
authors.initials: KA
authors.lastname: Horvath
mesh_terms: D000818:Animals; D001021:Aortic Valve / Q000033:anatomy & histology* / Q000601:surgery*; D003199:Computer Systems; D004867:Equipment Design; D019544:Equipment Failure Analysis; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation* / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000295:instrumentation* / Q000379:methods; D025321:Surgery, Computer-Assisted / Q000295:instrumentation* / Q000379:methods; D013552:Swine; D014584:User-Computer Interface