Mitral valve implantation using off-pump closed beating intracardiac surgery: a feasibility study

• Published in: Interactive cardiovascular and thoracic surgery 2007-10, Vol.6 (5), p.603-607
• Main Authors: Guiraudon, Gerard M, Jones, Douglas L, Bainbridge, Daniel, Peters, Terry M
• Format: Article
• Language: English
• Subjects: Animals; Echocardiography, Four-Dimensional; Echocardiography, Transesophageal; Equipment Design; Equipment Safety; Feasibility Studies; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - instrumentation; Image Interpretation, Computer-Assisted; Mitral Valve - diagnostic imaging; Mitral Valve - surgery; Surgery, Computer-Assisted - instrumentation; Swine; Ultrasonography, Interventional - methods; User-Computer Interface
• ISSN: 1569-9293; 1569-9285
• DOI: 10.1510/icvts.2007.154567

a Canadian Surgical Technologies and Advanced Robotics (CSTAR), Lawson Health Research Institute, CSTAR Legacy Building, LHSC-UC, 339 Windermere Road, London, Ontario, N6A 5A5, Canada b Department of Surgery, London, Ontario, N6A 5A5, Canada c Department of Physiology and Pharmacology, London, Ontario, N6A 5A5, Canada d Department of Medicine, London, Ontario, N6A 5A5, Canada e Department of Anesthesiology, London, Ontario, N6A 5A5, Canada f Department of Medical Biophysics, The University of Western Ontario, London, Ontario, N6A 5A5, Canada g Department of Radiology and Nuclear Physics, The University of Western Ontario, London, Ontario, N6A 5A5, Canada h Imaging Research Laboratories, Robarts Research Institute, London, Ontario, N6A 5A5, Canada *Corresponding author. Tel.: [phone] (ext 32645)/[phone]; fax: [phone]. E-mail address : gguiraud{at}uwo.ca (G.M. Guiraudon). We have developed the Universal Cardiac Introducer ® (UCI) with the aim of modernizing the off-pump, closed, beating, intracardiac approach. This paper reports our ongoing experience with positioning of a prosthetic MV, under image-guidance, substituting for direct vision. The UCI is comprised of two detachable parts: an attachment-cuff and an airlock-introductory chamber for bulky tools. A prosthetic MV was introduced into the left atrium in 12 pigs via the UCI (LA appendage). Transesophageal and 4D epicardial ultrasound were used for guidance. Limitations of ultrasound imaging prompted the development of a multimodality virtual reality (VR) system introduced in the last three animals. There were no complications associated with cardiac access, while achieving proper valve positioning. TEE contributed to navigating, while 4D epicardial ultrasound was adequate for positioning the prosthesis into the MV orifice. VR provided a 3D context for real-time US imaging with precise navigation and positioning using augmented reality representation of the valve. We demonstrated the feasibility of positioning MV prostheses via the UCI. These results suggest the tremendous potential of virtual reality in making access safe and effective for many intracardiac targets, with the ultimate goal of a safe, versatile, clinical application. Key Words: Experimental surgery; Mitral valve surgery; Off-pump surgery; Image-guidance; Virtual reality guidance; New technologies