Minimally Invasive Cardiac Surgery: Transapical Aortic Valve Replacement

Cardiothoracic Surgery Research Program, National Heart, Lung, and Blood Institute, National Institutes of Health, 9000 Rockville Pike, Bldg 10, B1D47, Bethesda, MD 20892, USA.
Minimally Invasive Surgery 10/2012; 2012(6):145381. DOI: 10.1155/2012/145381
Source: PubMed


Minimally invasive cardiac surgery is less traumatic and therefore leads to quicker recovery. With the assistance of engineering technologies on devices, imaging, and robotics, in conjunction with surgical technique, minimally invasive cardiac surgery will improve clinical outcomes and expand the cohort of patients that can be treated. We used transapical aortic valve implantation as an example to demonstrate that minimally invasive cardiac surgery can be implemented with the integration of surgical techniques and engineering technologies. Feasibility studies and long-term evaluation results prove that transapical aortic valve implantation under MRI guidance is feasible and practical. We are investigating an MRI compatible robotic surgical system to further assist the surgeon to precisely deliver aortic valve prostheses via a transapical approach. Ex vivo experimentation results indicate that a robotic system can also be employed in in vivo models.

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Available from: Ming Li, Oct 08, 2015
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    Gustaaf J Vrooijink · Tim T M Ellenbroek · Paul Breedveld · Jan G Grandjean · Sarthak Misra
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    ABSTRACT: Recent technological advancements in cardiovas-cular surgery such as transapical transcatheter aortic valve implantation (TA-TAVI) enabled treatment to elderly that were initially declined surgery. However, valve malpositioning during TA-TAVI have been reported in several cases. In this preliminary study, we present a novel approach in which a Robotically-Actuated Delivery Sheath (RADS) is used to potentially facilitate valve positioning. A model is developed that describes the shape and articulating tip position of the RADS. We developed a two-dimensional ultrasound tracking method that evaluates the tip position of the RADS in ultrasound images. Both modeling and ultrasound tracking are combined into an integrated system that facilitates closed-loop control of the articulating tip of the RADS. Experiments are performed in order to evaluate the tracking accuracy of the RADS. Experiments show mean positioning errors of approximately 2 mm along the x-and y-axes. Our study demonstrates that the RADS can potentially provide compensation for beating heart and respiratory motions during valve positioning and deployment in TA-TAVI.
    2014 IEEE International Conference on Robotics & Automation (ICRA); 06/2014