Safety and feasibility of novel technology fusing echocardiography and fluoroscopy images during MitraClip interventions

Sündermann, Simon H.; Biaggi, Patric; Grünenfelder, Jürg; Gessat, Michael; Felix, Carol; Béttex, Dominique; Falk, Volkmar; Corti, Roberto

doi:10.4244/eijv9i10a203

Cited by 59 publications

(42 citation statements)

References 11 publications

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“…The development of third and fourth generation percutaneous valves with advanced steering capabilities of the catheter has promoted the transseptal approach in recent publications [23,25,27]. The use of the recently developed real time fusion imaging techniques like EchoNavigator (Phillips Healthcare, Amsterdam, Netherlands) further facilitates such interventions [30,31]. The rate of mild paravalvular MR of 33% in our cohort reflects the results of others [26].…”

Section: Impact Of Treatment Strategy On Technical Resultssupporting

confidence: 62%

Percutaneous Treatment Options for Recurrent Mitral Valve Disease after Failed Mitral Valve Surgery

Bianda¹,

Gaemperli²,

Corti³

et al. 2017

AJCTS

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Objectives: Percutaneous treatment options have been described as an alternative to redo-surgery in high-risk patients with recurrent Mitral Regurgitation (MR) after failed Mitral Valve (MV) surgery. We aim to analyze the outcome of percutaneous MV interventions in such patients. Methods:Seventeen consecutive surgical intermediate to highrisk patients with recurrent MV disease not considered suitable for redo surgery were analyzed. Percutaneous MitraClip repair (n=11), valve-in-ring (n=3) or valve-in-valve (n=3) replacement were performed.Results: Median age was 76.0 years (53.6 to 89.4 years). Median EuroSCORE II and STS mortality score were 4.5% (0.5 to 14.4%) and 4.9% (1.5 to 20.9%), respectively. Pre-operative MR grade was moderate-severe (n=4, 24%) or severe (n=13, 76%). Interventional success was obtained in all but three cases (82%). 30 day survival rate was 100%. At last follow-up (mean 270 days, range 31 to 1559 days), the overall survival rate was 76%. MR grade was none-mild in 76% and moderate in 24% of patients. Reduction of dyspnea was achieved in all but 2 patients (88%). Conclusion:Percutaneous MV treatments after failed MV surgery are feasible and associated with a lower than expected periinterventional mortality in carefully selected patients not suitable for redo MV surgery. The interventions proved effective regarding reduction in MR and symptoms as well as lowering of pulmonary pressure.

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Section: Impact Of Treatment Strategy On Technical Resultssupporting

confidence: 62%

Percutaneous Treatment Options for Recurrent Mitral Valve Disease after Failed Mitral Valve Surgery

Bianda¹,

Gaemperli²,

Corti³

et al. 2017

AJCTS

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“…guidance has been utilized for directed transcatheter access, as well as for procedural interventions in the treatment of both valvular and paravalvular regurgitation(28)(29)(30)(31).TRANSCATHETER THERAPIES FOR AR NATIVE VALVES. Currently, there are no approved THVs for the treatment of native valve AR in the United States.…”

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confidence: 99%

Transcatheter Therapies for the Treatment of Valvular and Paravalvular Regurgitation in Acquired and Congenital Valvular Heart Disease

Ruiz

Kliger

Perk

et al. 2015

Journal of the American College of Cardiology

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Transcatheter therapies in structural heart disease have evolved tremendously over the past 15 years. Since the introduction of the first balloon-expandable valves for stenotic lesions with implantation in the pulmonic position in 2000, treatment for valvular heart disease in the outflow position has become more refined, with newer-generation devices, alternative techniques, and novel access approaches. Recent efforts into the inflow position and regurgitant lesions, with transcatheter repair and replacement technologies, have expanded our potential to treat a broader, more heterogeneous patient population. The evolution of multimodality imaging has paralleled these developments. Three- and 4-dimensional visualization and concomitant use of novel technologies, such as fusion imaging, have supported technical growth, from pre-procedural planning and intraprocedural guidance, to assessment of acute results and follow-up. A multimodality approach has allowed operators to overcome many limitations of each modality and facilitated integration of a multidisciplinary team for treatment of this complex patient population.

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“…30,31 Philips' EchoNavigator guided MitraClip procedures versus conventional TEE-XRF guided MitraClip procedures showed no differences in procedure time and radiation exposure, although a trend towards shorter procedure time was observed. 29,30 Interestingly, EchoNavigator allowed faster placement of two or more clips decreasing the time until the second or third clip by 6 min (83.2 ± 27.4 vs. 88.9 ± 29.0 min, p = 0.6) and 60 min (134.2 ± 23.2 vs. 199.5 ± 72.8 min, p = 0.4) minutes, respectively. 30 There is no literature on the use of Siemens' TrueFusion TEE-XRF fusion software in cardiac procedures.…”

Section: Different Implementations For Mitral Valve Interventionsmentioning

confidence: 88%

“…29,30 Interestingly, EchoNavigator allowed faster placement of two or more clips decreasing the time until the second or third clip by 6 min (83.2 ± 27.4 vs. 88.9 ± 29.0 min, p = 0.6) and 60 min (134.2 ± 23.2 vs. 199.5 ± 72.8 min, p = 0.4) minutes, respectively. 30 There is no literature on the use of Siemens' TrueFusion TEE-XRF fusion software in cardiac procedures. From the specifications and intended use, it can be deduced that the functionality of TrueFusion is comparable to EchoNavigator.…”

Section: Different Implementations For Mitral 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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Safety and feasibility of novel technology fusing echocardiography and fluoroscopy images during MitraClip interventions

Abstract: The use of EchoNavigator software was feasible and safe in all study patients. Further studies are necessary to confirm the benefits of using this software.

Cited by 59 publications

References 11 publications

Percutaneous Treatment Options for Recurrent Mitral Valve Disease after Failed Mitral Valve Surgery

Percutaneous Treatment Options for Recurrent Mitral Valve Disease after Failed Mitral Valve Surgery

Transcatheter Therapies for the Treatment of Valvular and Paravalvular Regurgitation in Acquired and Congenital Valvular Heart Disease

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

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