Perioperative DynaCT for improved imaging during transcatheter aortic valve implantation

Kempfert, Jörg; Merk, Denis R.; Noettling, Alois; John, Mathew; Linden, A. van der; Schuler, Gerhard; Linke, Axel; Noack, Thilo; Lehmkuhl, Lukas; Mohr, FW; Walther, T

doi:10.1055/s-0029-1246838

Cited by 9 publications

(13 citation statements)

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“…When it is impossible to perform the pre-procedure angiography, tomographic image reconstruction using the rotational acquisition program (DynaCT Aortic Valve Guide, Siemens AG; Munich, Germany), was also shown to be useful in determining the best view for the implantation. 20 Although the sequence of steps required for TAVI (attaining the access route, valvuloplasty, positioning, and release of the prosthesis) has not changed during the study period, there was significant reduction in the duration of the procedure and fluoroscopy time, a result of the greater skill and safety to cross the stenotic aortic valve, insert the rigid guide wire in the left ventricular cavity, and finally, to position and implant the prosthesis.…”

Section: Discussionmentioning

confidence: 99%

Impacto da Curva de Aprendizado na Seleção de Pacientes e nos Resultados Clínicos do Implante por Cateter de Prótese Aórtica

Siqueira¹,

Abizaid²,

Ramos³

et al. 2014

Rev. Bras. Cardiol. Invasiva

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Background: Transcatheter aortic valve implantation (TAVI) is an alternative treatment for high-risk or inoperable patients with aortic stenosis. The multidisciplinary team must undergo specific training and accumulate experience to achieve optimal results. However, its learning curve is not well established. Our objective was to investigate the impact of learning curve on patient selection, technical aspects and clinical outcomes of TAVI. Methods: Observational, prospective analysis of the first 150 patients undergoing transfemoral TAVI between January 2009 and December 2013. Patients were divided into tertiles (n = 50), according to the procedure date. Outcomes were defined according to Valve Academic Research Consortium-2 (VARC-2) criteria. Results: Mean age was 82.5 ± 6.7 years, 44% were male and 75% were in NYHA class III/IV. EuroS-CORE (24.2 ± 13% vs. 21.2 ± 10.8% vs. 23.4 ± 14.3%) and STS Score (5.9 ± 2.9% vs. 6.7 ± 4.3% vs. 5.8 ± 3.1%) were similar between groups. A gradual decrease was observed in procedure times (107.2 ± 48.1 minutes vs. 90.3 ± 42.2 minutes vs. 76.6 ± 37.7 minutes; p < 0.01), fluoroscopy times (31.3 ± 9,6 minutes vs. 25.4 ± 8.7 minutes vs. 17.2 ± 6.2 minutes; p = 0.01) and contrast volume (145.5 ± 70.9 mL vs. 123.2 ± 87.8 mL vs. 101.1 ± 50 mL; p = 0.01). Mortality decreased gradually (20% vs. 10% vs. 4%; p = 0,047), and lower bleeding and moderate-to-severe aortic regurgitation were observed in the third tertile (14% and 4%, respectively). There were no cases of reintervention, stroke or other clinical events between hospital discharge and 30-day follow-up. Conclusions: The competence in performing TAVI improved progressively as the number of patients treated increased and was associated with better clinical outcomes.

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Section: Discussionmentioning

confidence: 99%

Impacto da Curva de Aprendizado na Seleção de Pacientes e nos Resultados Clínicos do Implante por Cateter de Prótese Aórtica

Siqueira¹,

Abizaid²,

Ramos³

et al. 2014

Rev. Bras. Cardiol. Invasiva

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“…The development of new technologies and methods as angiographic 3-dimensional reconstruction of the aortic root [12,13] or CT co-registration integrated into the angiographic C-arm system [14][15][16] will probably be very helpful in the future for these complex cases.…”

Section: Discussionmentioning

confidence: 99%

Successful transfemoral aortic Edwards^®SAPIEN^® bioprosthesis implantation without using iodinated contrast media in a woman with severe allergy to contrast agent

Leroux

Dijos

Santos

2013

Cathet Cardio Intervent

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Severe anaphylactoid reaction after the use of iodinated contrast media are rare but can contraindicate the use of contrast agent. It was the case of a 53-year-old woman suffering from symptomatic severe aortic stenosis, recused for cardiac surgery because of deleterious effects of chest-wall irradiation, with porcelain aorta. We decided to implant a 23-mm Edwards(®) SAPIEN(®) transcatheter aortic valve via a femoral route without using any contrast media. The implantation was successful after surgical approach of the femoral artery, transesophageal echocardiography guiding, and localization of native leaflets and coronary trunk with catheters. Immediate and one month post-interventional follow-up was favorable and echocardiography showed a good functioning of the aortic bioprosthesis. Although conventional angiography is the best way to visualize the good positioning of the valve before deployment, our case suggests that, in special situations, transfemoral implantation of an Edwards(®) SAPIEN(®) aortic bioprosthesis is feasible without any contrast injection.

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“…An emerging technology not yet in routine clinical use that may aid TAVR intra‐procedurally is DynaCT (Siemens AG, Forchheim, Germany). This generates three‐dimensional cross‐sectional images of the aortic root on an angiographic C‐arm system by rotational angiography (200° in 5 s) during rapid ventricular pacing (180–220 beats per minute) with diluted contrast (25 mL), followed by automatic segmentation of the aortic root including automatic detection of the coronary ostia . The segmented images are then displayed in an online overlay mode, automatically registered to the fluoroscopic images .…”

Section: Clinical Applications Of Mdct In Structural Heart Interventionsmentioning

confidence: 99%

“…This generates three‐dimensional cross‐sectional images of the aortic root on an angiographic C‐arm system by rotational angiography (200° in 5 s) during rapid ventricular pacing (180–220 beats per minute) with diluted contrast (25 mL), followed by automatic segmentation of the aortic root including automatic detection of the coronary ostia . The segmented images are then displayed in an online overlay mode, automatically registered to the fluoroscopic images . Based on automatically detected lowest point of each aortic sinus, the system displays a graphical guiding‐tool to obtain an exact perpendicular fluoroscopic C‐arm view onto the aortic annulus to allow for optimal aortic valve implantation .…”

Section: Clinical Applications Of Mdct In Structural Heart Interventionsmentioning

confidence: 99%

Clinical utility of multi‐detector cardiac computed tomography in structural heart interventions

Gooley

Seneviratne

et al. 2016

J Med Imag Rad Onc

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In recent years, there have been major advances in structural interventional cardiology, which have revolutionized the practice of cardiology. Appropriate selection and follow-up of patients undergoing these structural heart interventions is vital. Multi-detector computed tomography (MDCT) has emerged as a key imaging modality in the peri-procedural assessment of patients undergoing multiple structural cardiac interventions. The purpose of this review is to provide an evidence-based clinical update on the roles of MDCT in both established and evolving structural heart interventions, including transcatheter aortic valve replacement (TAVR) and transcatheter mitral valve implantation (TMVI). The utility of MDCT in the peri-procedural assessment of patients undergoing pulmonary vein isolation (PVI) for atrial fibrillation, cardiac resynchronization therapy (CRT) and left atrial appendage (LAA) closure will also be reviewed.

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Perioperative DynaCT for improved imaging during transcatheter aortic valve implantation

Cited by 9 publications

References 0 publications

Impacto da Curva de Aprendizado na Seleção de Pacientes e nos Resultados Clínicos do Implante por Cateter de Prótese Aórtica

Impacto da Curva de Aprendizado na Seleção de Pacientes e nos Resultados Clínicos do Implante por Cateter de Prótese Aórtica

Successful transfemoral aortic Edwards^®SAPIEN^® bioprosthesis implantation without using iodinated contrast media in a woman with severe allergy to contrast agent

Clinical utility of multi‐detector cardiac computed tomography in structural heart interventions

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Perioperative DynaCT for improved imaging during transcatheter aortic valve implantation

Cited by 9 publications

References 0 publications

Impacto da Curva de Aprendizado na Seleção de Pacientes e nos Resultados Clínicos do Implante por Cateter de Prótese Aórtica

Impacto da Curva de Aprendizado na Seleção de Pacientes e nos Resultados Clínicos do Implante por Cateter de Prótese Aórtica

Successful transfemoral aortic Edwards®SAPIEN® bioprosthesis implantation without using iodinated contrast media in a woman with severe allergy to contrast agent

Clinical utility of multi‐detector cardiac computed tomography in structural heart interventions

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Successful transfemoral aortic Edwards^®SAPIEN^® bioprosthesis implantation without using iodinated contrast media in a woman with severe allergy to contrast agent