Automated 3D Analysis of Pre-Procedural MDCT to Predict Annulus Plane Angulation and C-Arm Positioning

Abstract

Automated 3D analysis of pre-implantation MDCT accurately predicts the LP of the aortic annulus and the corresponding C-arm position required for TAVR. With this approach, the implantation of the balloon-expandable prosthetic valve can be performed without an aortogram in the majority of cases and still be safe, with a low rate of valve malpositioning and regurgitation.

Definition of the aortic valve plane by means of a novel dedicated software program: Proof of concept and validation with multi slice computed tomography

“…However, MSCT seemed to provide more accurate valve deployment and reduce malposition, this needs to be confirmed for CAAS A-Valve in future studies. An important difference is that angiographic separation and correct sequence of the sinuses was a requirement of the definition of the OAP in the present study, but not in earlier studies [8,10] . When this requirement is not specifically addressed, the non-and right coronary sinuses may completely overlap in some patient anatomies in commonly used implantation views, which may lead to inadvertent positioning of the pigtail catheter in the right instead of the non-coronary sinus.…”

“…The importance of appropriate visualization of the aortic root in the various phases of TAVI (planning, execution and evaluation) is now widely recognized and has been subject of clinical research evaluating novel software for improved visualization of the aortic root including valve plane and on-line continuous assessment of the relation between the bioprosthesis and annulus [8][9][10][11][19][20][21][22] .…”

“…With respect to clinical relevance of OAP, Samim et al compared OAP derived from pre-TAVI MDCT by a dedicated automated 3D analysis system with conventional angiography and demonstrated that the first mentioned is associated with a reduction in contrast use, radiation and less kidney injury during TAVI [10] . In contrast to Samim et al, CAAS A-Valve requires two angiograms' and does not depend on a pre TAVI CT scan or conventional angiography with repeat injections, which could be also associated with less radiation exposure, less total contrast use and less kidney injury.…”

“…Safety of the procedure depends on, among others, correct positioning of the bioprosthesis since inaccurate or incorrect positioning may lead to a number of complications such as conduction disorders, paravalvular leakage and valve embolization [6] . Proper selection of the C-arm angulation in which the three aortic sinuses are depicted on one single line in the sequence of posterior, right and left sinus, the optimal angiographic projection (OAP), by contrast angiography during TAVI is essential [7][8][9][10][11] . Multi slice computed tomography (MSCT) is increasingly used to define OAP and is currently considered the gold standard [7,8,12] .…”

3D Hybrid Imaging for Structural and Congenital Heart Interventions in the Cath Lab

“…[22][23][24][25] Consequently, a reduction in peri-and post-interventional complications such as device malpositioning, paravalvular leakage, trauma of surrounding structures as well as other organ damage (acute kidney failure) was shown. 22,24 Excellent implant angles determined by Aortic Valve Guide are significantly more likely to be associated with no paravalvular regurgitation compared to satisfactory or poor implant angles (41.3% vs. 21.6%, respectively, p = 0.045) independent of operator experience. 22 HeartNavigator software (Philips Healthcare) has also shown to provide accurate prosthesis selection, comparable to gold standard CT assessment.…”