A navigation platform for guidance of beating heart transapical mitral valve repair

Abstract

Traditional approaches for repairing and replacing mitral valves have relied on placing the patient on cardiopulmonary bypass (on-pump) and accessing the arrested heart directly via a median sternotomy. However, because this approach has the potential for adverse neurological, vascular and immunological sequalae, there is a push towards performing such procedures in a minimally-invasive fashion. Nevertheless, preliminary experience on animals and humans has indicated that ultrasound guidance alone is often not sufficient. This paper describes the first porcine trial of the NeoChord DS1000 (Minnetonka, MN), employed to attach neochords to a mitral valve leaflet where the traditional ultrasound guided protocol has been augmented by dynamic virtual geometric models. In addition to demonstrating that the procedure can be performed with significantly increased precision and speed (up to 6 times), we also record and compare the trajectories used by each of five surgeons to navigate the NeoChord instrument. © 2012 Springer-Verlag.