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Towards real-time cardiovascular magnetic resonance guided transarterial CoreValve implantation: in vivo evaluation in swine

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Real-time cardiovascular magnetic resonance (rtCMR) is considered attractive for guiding TAVI. Owing to an unlimited scan plane orientation and an unsurpassed soft-tissue contrast with simultaneous device visualization, rtCMR is presumed to allow safe device navigation and to offer optimal orientation for precise axial positioning. We sought to evaluate the preclinical feasibility of rtCMR-guided transarterial aortic valve implatation (TAVI) using the nitinol-based Medtronic CoreValve bioprosthesis. Methods rtCMR-guided transfemoral (n = 2) and transsubclavian (n = 6) TAVI was performed in 8 swine using the original CoreValve prosthesis and a modified, CMR-compatible delivery catheter without ferromagnetic components. Results rtCMR using TrueFISP sequences provided reliable imaging guidance during TAVI, which was successful in 6 swine. One transfemoral attempt failed due to unsuccessful aortic arch passage and one pericardial tamponade with subsequent death occurred as a result of ventricular perforation by the device tip due to an operating error, this complication being detected without delay by rtCMR. rtCMR allowed for a detailed, simultaneous visualization of the delivery system with the mounted stent-valve and the surrounding anatomy, resulting in improved visualization during navigation through the vasculature, passage of the aortic valve, and during placement and deployment of the stent-valve. Post-interventional success could be confirmed using ECG-triggered time-resolved cine-TrueFISP and flow-sensitive phase-contrast sequences. Intended valve position was confirmed by ex-vivo histology. Conclusions Our study shows that rtCMR-guided TAVI using the commercial CoreValve prosthesis in conjunction with a modified delivery system is feasible in swine, allowing improved procedural guidance including immediate detection of complications and direct functional assessment with reduction of radiation and omission of contrast media.

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Published 01 January 2012
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Language English
Document size 3 MB
Kahlertet al.Journal of Cardiovascular Magnetic Resonance2012,14:21 http://www.jcmronline.com/content/14/1/21
R E S E A R C HOpen Access Towards realtime cardiovascular magnetic resonance guided transarterial CoreValve implantation: in vivo evaluation in swine 1* 22 23 34 Philipp Kahlert, Nina Parohl , Juliane Albert , Lena Schäfer , Renate Reinhardt , Gernot M Kaiser , Ian McDougall , 4 11 12 2,5 Brad Decker , Björn Plicht , Raimund Erbel , Holger Eggebrecht , Mark E Laddand Harald H Quick
Abstract Background:Realtime cardiovascular magnetic resonance (rtCMR) is considered attractive for guiding TAVI. Owing to an unlimited scan plane orientation and an unsurpassed softtissue contrast with simultaneous device visualization, rtCMR is presumed to allow safe device navigation and to offer optimal orientation for precise axial positioning. We sought to evaluate the preclinical feasibility of rtCMRguided transarterial aortic valve implatation (TAVI) using the nitinolbased Medtronic CoreValve bioprosthesis. Methods:rtCMRguided transfemoral (n = 2) and transsubclavian (n = 6) TAVI was performed in 8 swine using the original CoreValve prosthesis and a modified, CMRcompatible delivery catheter without ferromagnetic components. Results:rtCMR using TrueFISP sequences provided reliable imaging guidance during TAVI, which was successful in 6 swine. One transfemoral attempt failed due to unsuccessful aortic arch passage and one pericardial tamponade with subsequent death occurred as a result of ventricular perforation by the device tip due to an operating error, this complication being detected without delay by rtCMR. rtCMR allowed for a detailed, simultaneous visualization of the delivery system with the mounted stentvalve and the surrounding anatomy, resulting in improved visualization during navigation through the vasculature, passage of the aortic valve, and during placement and deployment of the stentvalve. Postinterventional success could be confirmed using ECGtriggered timeresolved cineTrueFISP and flowsensitive phasecontrast sequences. Intended valve position was confirmed by exvivo histology. Conclusions:Our study shows that rtCMRguided TAVI using the commercial CoreValve prosthesis in conjunction with a modified delivery system is feasible in swine, allowing improved procedural guidance including immediate detection of complications and direct functional assessment with reduction of radiation and omission of contrast media. Keywords:Aortic stenosis, Transcatheter aortic valve implantation, Cardiovascular magnetic resonance, Realtime
Background Transarterial aortic valve implantation (TAVI) has become a viable minimallyinvasive treatment option for highrisk and nonsurgical patients with severe sympto matic aortic stenosis [1]. Its remarkable clinical success has led to a revolutionary dissemination of this catheter
* Correspondence: philipp.kahlert@ukessen.de 1 Department of Cardiology, WestGerman Heart Center Essen, Essen University Hospital, University DuisburgEssen, Hufelandstrasse 55, 45122 Essen, Germany Full list of author information is available at the end of the article
based treatment, which is currently performed in an everincreasing number of patients with either the bal loonexpandable Edwards Sapien (Edwards Lifesciences Inc., Irvine, CA, USA)[2] or the selfexpandable Medtro nic CoreValve (Medtronic, Inc., Minneapolis, MN, USA) [3] bioprosthesis, especially since Conformité Europé enne approval. However, despite various advancements over the last years, TAVI remains a technically demand ing interventional procedure including various challen ging steps and a variety of potential procedural complications. A major procedural challenge during
© 2012 Kahlert et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.