Real-time magnetic resonance-guided aortic valve replacement using Engager valve

Bogdan A Kindzelski; Ming Li; Dumitru Mazilu; Timothy Hunt; Keith A Horvath

doi:10.1016/j.athoracsur.2014.09.017

Real-time magnetic resonance-guided aortic valve replacement using Engager valve

Ann Thorac Surg. 2014 Dec;98(6):2194-9. doi: 10.1016/j.athoracsur.2014.09.017. Epub 2014 Dec 1.

Authors

Bogdan A Kindzelski¹, Ming Li¹, Dumitru Mazilu¹, Timothy Hunt¹, Keith A Horvath²

Affiliations

¹ Cardiothoracic Surgery Research Program, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland.
² Cardiothoracic Surgery Research Program, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland. Electronic address: horvathka@mail.nih.gov.

Abstract

Purpose: New-generation stented bioprostheses coupled with better imaging modalities are expanding the clinical utility of transcatheter aortic valve replacement (TAVR). This study aimed at evaluating the feasibility of real-time cardiovascular magnetic resonance (rtCMR) -guided TAVR using the Medtronic Engager aortic valve system in a preclinical model.

Description: The Engager delivery device was slightly modified to make it CMR-compatible. Ten Yucatan swine underwent rtCMR-guided transapical TAVR. Postplacement phase-contrast and first-pass perfusion CMR sequences were used to evaluate for aortic regurgitation and myocardial perfusion, respectively.

Evaluation: Real-time CMR provided excellent visualization of cardiac anatomy during TAVR. Nine of 10 animals had proper valve placement in the aortic annulus as determined by CMR and confirmed by necropsy inspection. Postplacement phase-contrast scans confirmed no intravalvular or paravalvular leaks. Perfusion scans demonstrated sufficient coronary flow. Roentgenographs confirmed proper placement of the prostheses.

Conclusions: The Engager valve can be implanted transapically under rtCMR guidance with a modified, CMR-compatible delivery device in a preclinical model. Cardiovascular magnetic resonance allowed for accurate preplacement evaluation, real-time guidance, and postplacement functional assessment.

Publication types

Research Support, N.I.H., Extramural
Research Support, N.I.H., Intramural
Research Support, Non-U.S. Gov't

MeSH terms

Animals
Aortic Valve / surgery*
Aortic Valve Stenosis / surgery*
Bioprosthesis*
Disease Models, Animal
Heart Valve Prosthesis*
Magnetic Resonance Imaging, Cine / methods*
Prosthesis Design
Surgery, Computer-Assisted / methods*
Swine
Transcatheter Aortic Valve Replacement / methods*

Abstract

Publication types

MeSH terms

Grants and funding