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

Area of Science:

• Cardiovascular Surgery
• Medical Device Engineering
• Image-Guided Interventions

Background:

• Minimally invasive cardiac surgery requires advanced tools for intracardiac procedures.
• Current methods for prosthetic valve implantation often rely on direct visualization, limiting closed-heart approaches.

Purpose of the Study:

• To evaluate the feasibility and safety of the Universal Cardiac Introducer (UCI) for off-pump, beating-heart prosthetic mitral valve (MV) positioning.
• To assess the role of imaging guidance, including transesophageal echocardiography (TEE), 4D epicardial ultrasound, and virtual reality (VR), in this approach.

Main Methods:

• Development of the UCI, a two-part device for introducing bulky instruments.
• Prosthetic MV implantation in 12 pigs using the UCI via the left atrial appendage.
• Guidance using TEE and 4D epicardial ultrasound, with VR integration in the final three animals.

Main Results:

• Successful prosthetic MV positioning without cardiac access complications.
• TEE facilitated navigation; 4D epicardial ultrasound proved adequate for orifice positioning.
• VR enhanced 3D visualization, improving navigation and positioning accuracy via augmented reality.

Conclusions:

• The UCI is a feasible tool for prosthetic MV implantation in a beating heart.
• Multimodality imaging, particularly VR, significantly enhances precision and safety for intracardiac interventions.
• This technology holds potential for safe and versatile clinical applications in various intracardiac targets.