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

Area of Science:

• Cardiovascular Imaging
• Interventional Cardiology
• Biomedical Engineering

Background:

• Transcatheter aortic valve replacement (TAVR) is expanding clinically due to advanced bioprostheses and imaging.
• Real-time cardiovascular magnetic resonance (rtCMR) offers high-resolution anatomical visualization.

Purpose of the Study:

• To assess the feasibility of rtCMR-guided TAVR using the Medtronic Engager valve system.
• To evaluate rtCMR guidance in a preclinical transapical TAVR model.

Main Methods:

• The Medtronic Engager delivery device was modified for CMR compatibility.
• Ten Yucatan swine underwent transapical TAVR guided by rtCMR.
• Post-procedure CMR assessed aortic regurgitation and myocardial perfusion.

Main Results:

• rtCMR provided excellent visualization of cardiac anatomy during the procedure.
• Nine out of ten animals achieved proper valve placement, confirmed by necropsy.
• Postplacement CMR confirmed no significant aortic regurgitation and adequate coronary perfusion.

Conclusions:

• Transapical TAVR with the Engager valve is feasible using a modified, CMR-compatible device under rtCMR guidance in a preclinical setting.
• rtCMR facilitates accurate preplacement assessment, real-time procedural guidance, and postplacement functional evaluation.