A planning system for transapical aortic valve implantation

Gessat, Michael; Merk, Denis R.; Falk, Volkmar; Walther, Thomas; Jacobs, Stefan; Nöttling, Alois; Burgert, Oliver

doi:10.1117/12.810270

Cited by 18 publications

(16 citation statements)

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“…coronary ostia, in 2D fluoroscopic image sequences with an error margin which will result in total maximum margin errors of misplaced prosthesis within the clinical acceptable range. The accuracy of valve implantation may be also improved by registering a 3D model of the aorta which is preoperatively obtained from CT or dynamic intra-operative CT images [26] to 2D intra-operative fluoroscopic image sequences of the TA-AVI.…”

Section: Discussionmentioning

confidence: 99%

Aortic valve prosthesis tracking for transapical aortic valve implantation

et al. 2010

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Purpose Transapical aortic valve implantation (TA-AVI) is a new minimally invasive surgical treatment of aortic stenosis for high risk patients. The placement of aortic valve prosthesis (AVP) is performed under 2D Xray fluoroscopic guidance. Difficult clinical complications can arise if the implanted valve is misplaced. Therefore we present a method to track the AVP in 2D X-ray fluoroscopic images in order to improve the accuracy of the TA-AVI. MethodsThe proposed tracking method includes the template matching approach to estimate the position of AVP and a shape model of the prosthesis to extract the corner points of the AVP in each image of sequence. To start the AVP tracking procedure, an initialization step is performed by manually defining the corner points of the prosthesis in the first image of sequence to provide the required algorithm parameters such as the AVP model parameters.Results We evaluated the AVP tracking method on six 2D intra-operative fluoroscopic image sequences. The results of automatic AVP localization agree well with manually-defined AVP positions. The maximum localization errors of tracked prosthesis are less than 1 mm and within the clinical accepted range.Conclusions For assisting the TA-AVI, a method for tracking the AVP in 2D X-ray fluoroscopic image sequences has been developed. Our AVP tracking method is a first step towards automatic optimal placement of the AVP during the TA-AVI.

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Section: Discussionmentioning

confidence: 99%

Aortic valve prosthesis tracking for transapical aortic valve implantation

et al. 2010

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“…We have developed preoperative planning software to measure the required size of the implant and to determine its optimal position [6]. The developed software is able to import 3-D images directly from the Siemens DynaCT imaging device or from a PACS.…”

Section: A Preoperative Planning Softwarementioning

confidence: 99%

Towards a new image guidance system for assisting transapical minimally invasive aortic valve implantation

Karar

Gessat

Walther

et al. 2009

2009 Annual International Conference of the IEEE Engineering in Medicine and Biology Society

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We propose a new image guidance system for assisting transapical minimally invasive aortic valve implantation. The goal is to define the exact positioning of aortic valve prosthesis, preventing the misplacement of the valve. The proposed system consists of two stand-alone modules. First, preoperative planning software uses DynaCT images with manual anatomical landmarks to calculate the size and optimal position of the prosthesis. Second, an intraoperative system is developed for tracking of the prosthesis and the coronary ostia in 2-D fluoroscopic images. Then the safe area of implantation is defined. The preliminary experimental results of preoperative planning and intraoperative tracking system are promising.Abstract-We propose a new image guidance system for assisting transapical minimally invasive aortic valve implantation. The goal is to define the exact positioning of aortic valve prosthesis, preventing the misplacement of the valve. The proposed system consists of two stand-alone modules. First, preoperative planning software uses DynaCT images with manual anatomical landmarks to calculate the size and optimal position of the prosthesis. Second, an intraoperative system is developed for tracking of the prosthesis and the coronary ostia in 2-D fluoroscopic images. Then the safe area of implantation is defined. The preliminary experimental results of preoperative planning and intraoperative tracking system are promising.

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“…For optimal valve selection the geometry of the aortic root as a whole needs to be considered. In 2009, the usage of geometric 3D models of the implants ('implant templates') was proposed as a means to give visual feedback on the fit between implant and anatomy during T-AVI planning [24]. The system guides the user through a landmark detection process that aims to establish a simplified model of the aortic root anatomy [18].…”

Section: Template-based Planningmentioning

confidence: 99%

Transcatheter aortic valve implantation. Role of imaging

Gessat

Frauenfelder

Altwegg

et al. 2011

Aswan Heart Centre Science &Amp; Practice Series

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Transcatheter aortic valve implantation (T-AVI) has shown good results in high-risk patients with severe aortic stenosis. Throughout the whole process of T-AVI, different imaging modalities are indispensable. Preoperatively, multislice computed tomography, angiography and transesophageal echo (TEE) are utilized for patient selection, valve selection, approach selection and the planning of implant placement. Intraoperatively, angiography and TEE are used for controlling placement of the guidewire and valve positioning. Quality control and follow-up require TEE imaging and can require additional CT or angiography studies. In the first half of this paper, we discuss the applicability of different imaging modalities for T-AVI in the light of the current best practice. In the second half of this paper, we present an overview on research projects in medical engineering which aim at development of imagebased methods for increasing patient safety during T-AVI. Template-based implantation planning, as it is applied in dental, orthopedic and other surgical disciplines, is proposed as an aid during implant selection in order to help reduce the incidence of complications such as atrioventricular node block and paravalvular leaks. Current research tries to apply state-of-the-art engineering techniques, such as computational fluid dynamics to optimize valve selection and positioning. For intraoperative assistance during valve positioning, real-time image processing methods are proposed to track target landmarks and the stented valve. ABSTRACTTranscatheter aortic valve implantation (T-AVI) has shown good results in high-risk patients with severe aortic stenosis. Throughout the whole process of T-AVI, different imaging modalities are indispensable. Preoperatively, multislice computed tomography, angiography and transesophageal echo (TEE) are utilized for patient selection, valve selection, approach selection and the planning of implant placement. Intraoperatively, angiography and TEE are used for controlling placement of the guidewire and valve positioning. Quality control and follow-up require TEE imaging and can require additional CT or angiography studies. In the first half of this paper, we discuss the applicability of different imaging modalities for T-AVI in the light of the current best practice.In the second half of this paper, we present an overview on research projects in medical engineering which aim at development of image-based methods for increasing patient safety during T-AVI. Template-based implantation planning, as it is applied in dental, orthopedic and other surgical disciplines, is proposed as an aid during implant selection in order to help reduce the incidence of complications such as atrioventricular node block and paravalvular leaks. Current research tries to apply state-of-the-art engineering techniques, such as computational fluid dynamics to optimize valve selection and positioning. For intraoperative assistance during valve positioning, real-time image processing methods are proposed to t...

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A planning system for transapical aortic valve implantation

Cited by 18 publications

References 0 publications

Aortic valve prosthesis tracking for transapical aortic valve implantation

Aortic valve prosthesis tracking for transapical aortic valve implantation

Towards a new image guidance system for assisting transapical minimally invasive aortic valve implantation

Transcatheter aortic valve implantation. Role of imaging

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