Robot-assisted real-time magnetic resonance image–guided transcatheter aortic valve replacement

Abstract

OBJECTIVE 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.

New Model for the Assessment of Transcatheter Aortic Valve Replacement Devices in Sheep

“…Moreover, the banding model requires a thoracotomy and band placement before TAVR deployment, which makes a more complicated surgical procedure and recovery on the day of TAVR deployment. There have also been attempts to interventionally insert oversized valves into the healthy aortic valve to overcome the lack of stiff calcified anchoring points, but even this approach is subject to valve migration, paravalvular leaks, and aortic insufficiency [18][19][20][21][22][23][24][25].…”

Accuracy of Robotic-Assisted Spinal Surgery—Comparison to TJR Robotics, da Vinci Robotics, and Optoelectronic Laboratory Robotics

“…The collective effect of testing methodology and limited experimental coordinate transformations between data input/output reduces error propagation and maximizes optoelectronic accuracy (Figure 2, Table ). [91][92][93][94][95][96][97] Application Accuracy: Clinical Operative Platform Transitioning from controlled laboratory conditions to the dynamic variability of a clinical operative environment presents a different set of application challenges for maintaining peak optoelectronic accuracy. Unique to robotic-assisted surgery and in contrast to the laboratory setting, the intraoperative process requires considerably more steps in the transference of optoelectronic kinematic data.…”

MRI Robots for Needle-Based Interventions: Systems and Technology

“…Recently, a non-survival study on eight swine using an Innomotion system, a general percutaneous intervention robot developed by Melzer et al [74], was conducted to show the feasibility of interactive MRI-guided transcatheter aortic valve replacement [75]. Previously, Li et al [76] also utilized an Innomotion system with an embedded 3 DoF valve delivery module for MRI-guided insertion of aortic valve prostheses.…”