Pneumatic actuated robotic assistant system for aortic valve replacement under MRI guidance

National Institutes of Health, Bethesda, MD 20892, USA.
IEEE transactions on bio-medical engineering (Impact Factor: 2.23). 10/2010; 58(2):443-51. DOI: 10.1109/TBME.2010.2089983
Source: PubMed

ABSTRACT We present a pneumatic actuated robotic assistant system for transapical aortic valve replacement under MRI guidance in a beating heart. This is a minimally invasive procedure that is currently performed manually inside the MRI bore. A robotic assistance system that integrates an interactive real-time MRI system, a robotic arm with a newly developed robotic valve delivery module, as well as user interfaces for the physician to plan the procedure and manipulate the robot, would be advantageous for the procedure. An Innomotion arm with hands-on cooperative interface was used as a device holder. A compact MRI compatible robotic delivery module was developed for delivering both balloon-expandable and self-expanding prostheses. A compact fiducial that can be placed close to the volume of interest and requires a single image plane was used for image-based robot registration. The system provides different user interfaces at various stages of the procedure. We present the development and evaluation of the components and the system in ex-vivo experiments.

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Available from: Keith A Horvath, Aug 24, 2015
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    • "Robotic systems have been developed for the TAVI using intraoperative MRI guidance (Li et al., 2008, 2011). Real-time 3D transesophageal (TEE) is recently presented for guiding the TAVI (Siegel et al., 2011). "
    Aortic Valve, 12/2011; , ISBN: 978-953-307-561-7
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    ABSTRACT: This paper presents a method for assisting the placement of stented aortic valve prosthesis during minimally invasive off-pump transcatheter aortic valve implantation (TAVI) under live 2-D X-ray fluoroscopy guidance. The proposed method includes a dynamic overlay of an intra-operative 3-D aortic root mesh model and an estimated target area of valve implantation onto live 2-D fluoroscopic images. This is based on a template-based tracking procedure of a pigtail catheter without further injections of contrast agent. Minimal user-interaction is required to initialize the algorithm and to correct fluoroscopy overlay errors if needed. Retrospective experiments were carried out on ten patient datasets from the clinical routine of the TAVI. The mean displacement errors of the updated aortic root mesh model overlays are less than 2.0 mm without manual overlay corrections. The results show that the guidance performance of live 2-D fluoroscopy is potentially improved when using our proposed method for the TAVIs.
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    ABSTRACT: Aortic valve stenosis is one of the most frequently acquired valvular heart diseases, accounting for almost 70% of valvular cardiac surgery. Transapical transcatheter aortic valve implantation has recently become a suitable minimally invasive technique for high-risk and elderly patients with severe aortic stenosis. In this article, we aim to automatically define a target area of valve implantation, namely, the area between the coronary ostia and the lowest points of two aortic valve cusps. Therefore, we present a new image-based tracking method of these aortic landmarks to assist in the placement of aortic valve prosthesis under live 2D fluoroscopy guidance. We propose a rigid intensity-based image registration technique for tracking valve landmarks in 2D fluoroscopic image sequences, based on a real-time alignment of a contrast image including the initialized manual valve landmarks to each image of sequence. The contrast image is automatically detected to visualize aortic valve features when the aortic root is filled with a contrast agent. Our registration-based tracking method has been retrospectively applied to 10 fluoroscopic image sequences from routine transapical aortic valve implantation procedures. Most of all tested fluoroscopic images showed a successful tracking of valve landmarks, especially for the images without contrast agent injections. A new intraoperative image-based method has been developed for tracking aortic valve landmarks in live 2D fluoroscopic images to assist transapical aortic valve implantations and to increase the overall safety of surgery as well.
    Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery 07/2011; 6(4):231-6. DOI:10.1097/IMI.0b013e31822c6a77
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