Preclinical Multimodality Fusion Imaging Platform to Optimize Catheter-Based Mitral Valve Interventions

Background: Preclinical translational animal models are fundamental for the development of new mitral interventions. The aim of this study was to report the feasibility of a pre-clinical multimodality imaging platform to test the full spectrum of contemporary advanced technologies, from preoperative virtual planning to the latest generation intraprocedural imaging guidance.

Methods: Five female swine (n = 5) were operated in hybrid animal lab with transcatheter MitraClip mitral valve repair, as training procedures after creation of a mitral flail. They underwent at baseline cardiac computed tomography, cardiac magnetic resonance imaging and the procedure was guided by means of transesophageal echocardiography and intracardiac echocardiography. Live real-time echo-fluoro fusion imaging with investigational prototype was adopted.

Results: Combination of all contemporary imaging modalities was successfully adopted to guide MitraClip in this experimental setting. The training procedures were successfully performed in all animals. The transseptal access was achieved in all cases, although a re-crossing was required in one case due to the loss of transseptal access. The clip was implanted in all animals except one in the target region, with a mean procedure time of 69 ± 15 minutes and mean fluoroscopy time of 47 ± 12 minutes. No adverse events occurred.

Conclusions: The feasibility of a pre-clinical multimodality-imaging platform to optimize catheter-based mitral interventions has been demonstrated. This set-up offers all contemporary advanced imaging modalities to guide hybrid training programs and to implement next generation imaging modalities.