Impact of optimising fluoroscopic implant angles on paravalvular regurgitation in transcatheter aortic valve replacements – utility of three-dimensional rotational angiography

Poon, K.; Crowhurst, J.; James, Christopher W.; Campbell, D.; Roper, Damian; Chan, Jonathan; Incani, A.; Clarke, Andrew; Tesar, Peter; Aroney, Constantine N.; Raffel, Corey; Walters, D.

doi:10.4244/eijv8i5a84

Cited by 31 publications

(22 citation statements)

References 20 publications

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“…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. 26 In addition, Philips' HeartNavigator has shown to provide accurate planning and guidance to obtain transapical access for, amongst others, paravalvular leakage repair.…”

Section: Different Implementations For Aortic Valve Interventionsmentioning

confidence: 86%

“…41 Furthermore, compared to pre-procedural CT, the radiation and contrast exposure of CBCT is significantly lower. 11,22 TEE-XRF fusion is increasingly used in mitral valve repair and various CHD procedures. The major advantage is the use of real-time fusion of two important imaging modalities.…”

Section: Discussionmentioning

confidence: 99%

“…[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.…”

Section: Different Implementations For Aortic Valve Interventionsmentioning

confidence: 99%

“…These software packages can automatically delineate the aortic root in CT or CBCT images and calculate the aortic valve deployment angles based on the position and orientation of the aortic valve annulus. 22 Markers of the aortic root, left and right coronary ostia are automatically superimposed on the live XRF images, thus facilitating intuitive navigation and maneuvering ( Figure 2). 22 Furthermore, accurate deployment angles are provided for aortic valve placement.…”

Section: Solutions For Aortic Valve Interventionsmentioning

confidence: 99%

“…22 Markers of the aortic root, left and right coronary ostia are automatically superimposed on the live XRF images, thus facilitating intuitive navigation and maneuvering ( Figure 2). 22 Furthermore, accurate deployment angles are provided for aortic valve placement.…”

Section: Solutions For Aortic Valve Interventionsmentioning

confidence: 99%

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

Broek

Krings

et al. 2018

Structural Heart

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Hybrid imaging (HI) during cardiovascular interventions enables the peri-procedural visualization of the organs and tissues by means of integrating different imaging modalities. HI can improve the procedural efficacy and safety. This review provides an overview of different systems, their possibilities and the current clinical use and benefits focused on structural and congenital heart diseases. We have performed a literature search and linked the software options to the clinical use in cardiology to gain insight into the clinical use of the systems. In this review, we focus on radiation and contrast exposure, complication rate and procedure time. We found that currently available studies are limited by small cohorts. Nevertheless, HI systems for valvular procedures result in a significant decrease of radiation and contrast exposure. The largest benefit hereof is observed when HI is used in combination with rotational angiography. Furthermore, automatically determined optimal implant angle for transcatheter aortic valve implantation decreases the complication rate significantly. Congenital heart disease interventions that require 2D/3D Transoesophageal echocardiography (TEE) such as septal defects show a significant decrease in radiation and contrast exposure and procedural time when using TEE-Mono-and bi-plane cine angiography and fluoroscopy (XRF) fusion software. MitraClip procedures using these HI systems, however, show only a trend in decrease of these effects. In conclusion, major interventional X-ray vendors offer HI software solutions which are safe and can aid the planning and image guidance of cardiovascular interventions. Even though current HI technologies have limitations, HI provides support in the increasingly complex cardiac interventional procedures to provide better patient care.

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Section: Different Implementations For Aortic Valve Interventionsmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Different Implementations For Aortic Valve Interventionsmentioning

confidence: 99%

Section: Solutions For Aortic Valve Interventionsmentioning

confidence: 99%

Section: Solutions For Aortic Valve Interventionsmentioning

confidence: 99%

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

Broek

Krings

et al. 2018

Structural Heart

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Correlation of aortic valve annular plane assessment by on‐table three‐dimensional rotational angiography and preprocedural computed tomography

Tanner

Murphy

Malone

et al. 2022

Cathet Cardio Intervent

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Objectives: To assess the correlation between the aortic valve annular plane (AVAP) obtained by preprocedural computed tomography (CT) with on-table three-dimensional rotational angiography (3DRA), in patients undergoing transcatheter aortic valve replacement (TAVR).Background: Accurate assessment of the AVAP is critical during TAVR procedures to enable optimal positioning and minimize complications. Most commonly, preprocedural CT has been used to determine the AVAP. However, this can differ from the actual AVAP obtained during the TAVR procedure. Methods:Consecutive TAVR patients at a single center undergoing both preprocedural CT and 3DRA were included in the study. The AVAP assessment by CT was performed using 3mensio software (Pie Medical Imaging). 3DRA assessment was performed using DynaCT (Siemens).Results: A total of 100 patients were included in the analysis. A difference of ≥5°and ≥10°in both the LAO/RAO and cranial/caudal components of the AVAP projection angle as assessed by CT and 3DRA was recorded in 39% and 10% of patients, respectively. The concordance correlation coefficient for the LAO/RAO and cranial/ caudal implantation angles was 0.519 (95% CI: 0.377-0.661) and 0.558 (95% CI: 0.432-0.684), respectively. Conclusion:Correlation between preprocedural CT and on-table 3DRA in the prediction of the actual AVAP at the time of TAVR implantation is moderate.

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The effect of X‐ray beam distortion on the Edwards Sapien XT^™ trans‐catheter aortic valve replacement prosthesis

Crowhurst

Poon

Incani

et al. 2015

J of Medical Radiation Sci

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IntroductionProfiling the Aortic root perpendicular to the fluoroscopic image plane will achieve a more successful implant position for trans‐catheter aortic valve replacement (TAVR). This study aimed to investigate whether the divergent nature of the X‐ray beam from the C‐arm altered the appearance of the TAVR device.MethodsUnder bench‐top testing, a 23, 26 and 29 mm Edwards Sapien XT valve was positioned coaxially at the bottom of a fluoroscopic image utilising 22 and 32 cm fields of view (FOV). The table was then moved so that the valve was positioned at the top of the image. The valve's appearance was scored using a previously published three tier classification tool (excellent, satisfactory and poor) and quantified with measurements. The number of degrees of C‐arm rotation that were required to bring the valve back to a coaxial appearance was recorded.ResultsWhen using the 32 cm FOV, the valve's appearance changes from excellent to satisfactory. When a 22 cm FOV was used, the change is less marked. More C‐arm rotation is required to bring the appearance back to coaxial with the 32 cm FOV.ConclusionNot maintaining the valve in the centre of the image can distort the valves appearance. This has the potential to affect the final implantation depth.

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Impact of optimising fluoroscopic implant angles on paravalvular regurgitation in transcatheter aortic valve replacements – utility of three-dimensional rotational angiography

Abstract: Optimising implant angles may be important in reducing PVR. This is significantly more likely to be achieved with AVG rotational angiography.

Cited by 31 publications

References 20 publications

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

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

Correlation of aortic valve annular plane assessment by on‐table three‐dimensional rotational angiography and preprocedural computed tomography

The effect of X‐ray beam distortion on the Edwards Sapien XT^™ trans‐catheter aortic valve replacement prosthesis

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Impact of optimising fluoroscopic implant angles on paravalvular regurgitation in transcatheter aortic valve replacements – utility of three-dimensional rotational angiography

Abstract: Optimising implant angles may be important in reducing PVR. This is significantly more likely to be achieved with AVG rotational angiography.

Cited by 31 publications

References 20 publications

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

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

Correlation of aortic valve annular plane assessment by on‐table three‐dimensional rotational angiography and preprocedural computed tomography

The effect of X‐ray beam distortion on the Edwards Sapien XT™ trans‐catheter aortic valve replacement prosthesis

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The effect of X‐ray beam distortion on the Edwards Sapien XT^™ trans‐catheter aortic valve replacement prosthesis