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Robotic-assisted real-time MRI-guided TAVR: from system deployment to in vivo experiment in swine model

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International Journal of Computer Assisted Radiology and Surgery Aims and scope Submit manuscript

Abstract

Purpose

Real-time magnetic resonance imaging (rtMRI) guidance provides significant advantages during transcatheter aortic valve replacement (TAVR) as it provides superior real-time visualization and accurate device delivery tracking. However, performing a TAVR within an MRI scanner remains difficult due to a constrained procedural environment. To address these concerns, a magnetic resonance (MR)-compatible robotic system to assist in TAVR deployments was developed. This study evaluates the technical design and interface considerations of an MR-compatible robotic-assisted TAVR system with the purpose of demonstrating that such a system can be developed and executed safely and precisely in a preclinical model.

Methods

An MR-compatible robotic surgical assistant system was built for TAVR deployment. This system integrates a 5-degrees of freedom (DoF) robotic arm with a 3-DoF robotic valve delivery module. A user interface system was designed for procedural planning and real-time intraoperative manipulation of the robot. The robotic device was constructed of plastic materials, pneumatic actuators, and fiber-optical encoders.

Results

The mechanical profile and MR compatibility of the robotic system were evaluated. The system-level error based on a phantom model was 1.14 ± 0.33 mm. A self-expanding prosthesis was successfully deployed in eight Yorkshire swine under rtMRI guidance. Post-deployment imaging and necropsy confirmed placement of the stent within 3 mm of the aortic valve annulus.

Conclusions

These phantom and in vivo studies demonstrate the feasibility and advantages of robotic-assisted TAVR under rtMRI guidance. This robotic system increases the precision of valve deployments, diminishes environmental constraints, and improves the overall success of TAVR.

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Acknowledgments

This research was made possible by funding from the Intramural Research Program of the National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), US Department of Health and Human Services (DHHS)

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Authors and Affiliations

  1. Cardiothoracic Surgery Research Program, National Heart, Lung and Blood Institute, National Institutes of Health, Building 10, Room B1D47, MSC 1550, 10 Center Drive, Bethesda, MD, 20892, USA

    Joshua L. Chan, Dumitru Mazilu, Justin G. Miller, Timothy Hunt, Keith A. Horvath & Ming Li

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  1. Joshua L. Chan
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  2. Dumitru Mazilu
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  3. Justin G. Miller
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Correspondence to Ming Li.

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All applicable international, national, and/or institutional guidelines for the care and use of animals were followed. All procedures performed in studies involving animals were in accordance with the ethical standards of the institution at which the studies were conducted.

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Chan, J.L., Mazilu, D., Miller, J.G. et al. Robotic-assisted real-time MRI-guided TAVR: from system deployment to in vivo experiment in swine model. Int J CARS 11, 1905–1918 (2016). https://doi.org/10.1007/s11548-016-1421-4

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  • DOI: https://doi.org/10.1007/s11548-016-1421-4

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