The critical role of imaging navigation and guidance in transcatheter aortic valve implantation

Lang, Pencilla; Peters, Terry M.; Kiaii, Bob; Chu, Michael

doi:10.1016/j.jtcvs.2012.02.010

Cited by 6 publications

(7 citation statements)

References 18 publications

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“…12,13 For this reason, TEE has been proposed as a bridging modality, allowing preoperative models to be registered into the intraoperative environment. Lang et al 3 proposed using TEE to register preoperative CT models to fluoroscopy to improve image guidance without requiring rotational angiography. Luo et al 17 proposed a system using magnetic tracking of the TEE and catheter to eliminate the need for fluoroscopy entirely.…”

Section: Discussionmentioning

confidence: 99%

“…The magnetic tracking system retails for approximately US $18,000, and each single use sensor is US $250. 3 This is less than the infrastructure costs of most currently available intraoperative image guidance systems including DynaCT, MRI, and hybrid operating rooms.…”

Section: Discussionmentioning

confidence: 99%

“…Implantation of the valved stent too far above the aortic valve annulus may result in embolism of the valved stent or coronary occlusion by the valved stent, whereas positioning the valved stent too far below the aortic valve annulus may cause atrioventricular block requiring a permanent pacemaker or retrograde embolization. 3 Navigation and deployment of the valved stent during TAVI relies largely on single-plane fluoroscopy; however, this imaging modality has several limitations.…”

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confidence: 99%

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Augmented Reality System for Ultrasound Guidance of Transcatheter Aortic Valve Implantation

Currie

McLeod

Moore

et al. 2016

Innovations�(Phila)

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Objective Transcatheter aortic valve implantation (TAVI) relies on fluoroscopy and nephrotoxic contrast medium for valve deployment. We propose an alternative guidance system using augmented reality (AR) and transesophageal echocardiography (TEE) to guide TAVI deployment. The goals of this study were to determine how consistently the aortic valve annulus is defined from TEE using different aortic valve landmarks and to compare AR guidance with fluoroscopic guidance of TAVI deployment in an aortic root model. Methods Magnetic tracking sensors were integrated into the TAVI catheter and TEE probe, allowing these tools to be displayed in an AR environment. Variability in identifying aortic valve commissures and cuspal nadirs was assessed using TEE aortic root images. To compare AR guidance of TAVI deployment with fluoroscopic guidance, a TAVI stent was deployed 10 times in the aortic root model using each of the two guidance systems. Results Commissures and nadirs were both investigated as features for defining the valve annulus in the AR guidance system. The commissures were identified more consistently than the nadirs, with intraobserver variability of 2.2 and 3.8 mm, respectively, and interobserver variability of 3.3 and 4.7 mm, respectively. The precision of TAVI deployment using fluoroscopic guidance was 3.4 mm, whereas the precision of AR guidance was 2.9 mm, and its overall accuracy was 3.4 mm. This indicates that both have similar performance. Conclusions Aortic valve commissures can be identified more reliably than cuspal nadirs from TEE. The AR guidance system achieved similar deployment accuracy to that of fluoroscopy while eliminating the use and consequences of nephrotoxic contrast and radiation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Augmented Reality System for Ultrasound Guidance of Transcatheter Aortic Valve Implantation

Currie

McLeod

Moore

et al. 2016

Innovations�(Phila)

Self Cite

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“…21 Our AR imaging guidance platform is much more cost-effective, with the magnetic tracking system retailing for approximately $18,000 USD and $250 USD for each single-use sensor. In addition, the AR system is portable, avoids irradiation, and does not impede normal operating room workflow.…”

Section: Discussionmentioning

confidence: 99%

“…As a result, current imaging modalities provide limited intracardiac views that make transcatheter manipulation of the MV challenging and can result in prolonged procedural times, additional device deployments, excessive radiation exposure, and most importantly, increased complication rates. 18,21 Although many advances have occurred in transcatheter valve therapy designs, there remains great dependence on current imaging modalities and their known limitations. 21 A variety of AR imaging guidance systems have been developed to facilitate intracardiac beating heart surgery.…”

Section: Discussionmentioning

confidence: 99%

Augmented Reality Image Guidance Improves Navigation for Beating Heart Mitral Valve Repair

Chu

Moore

Peters

et al. 2012

Innovations�(Phila)

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Objective Emerging off-pump beating heart valve repair techniques offer patients less invasive alternatives for mitral valve (MV) repair. However, most of these techniques rely on the limited spatial and temporal resolution of transesophageal echocardiography (TEE) alone, which can make tool visualization and guidance challenging. Methods Using a magnetic tracking system and integrated sensors, we created an augmented reality (AR) environment displaying virtual representations of important intracardiac landmarks registered to biplane TEE imaging. In a porcine model, we evaluated the AR guidance system versus TEE alone using the transapically delivered NeoChord DS1000 system to perform MV repair with chordal reconstruction. Results Successful tool navigation from left ventricular apex to MV leaflet was achieved in 12 of 12 and 9 of 12 (P = 0.2) attempts with AR imaging and TEE alone, respectively. The distance errors of the tracked tool tip from the intended midline trajectory (5.2 ± 2.4 mm vs 16.8 ± 10.9 mm, P = 0.003), navigation times (16.7 ± 8.0 seconds vs 92.0 ± 84.5 seconds, P = 0.004), and total path lengths (225.2 ± 120.3 mm vs 1128.9 ± 931.1 mm, P = 0.003) were significantly shorter in the AR-guided trials compared with navigation with TEE alone. Furthermore, the potential for injury to other intracardiac structures was nearly 40-fold lower when using the AR imaging for tool navigation. The AR guidance also seemed to shorten the learning curve for novice surgeons. Conclusions Augmented reality–enhanced TEE facilitates more direct and safe intracardiac navigation of the NeoChord DS tool from left ventricular apex to MV leaflet. Tracked tool path results demonstrate fourfold improved accuracy, fivefold shorter navigation times, and overall improved safety with AR imaging guidance.

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Phantom study of an ultrasound guidance system for transcatheter aortic valve implantation

McLeod

Currie

Moore

et al. 2016

Computerized Medical Imaging and Graphics

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The critical role of imaging navigation and guidance in transcatheter aortic valve implantation

Cited by 6 publications

References 18 publications

Augmented Reality System for Ultrasound Guidance of Transcatheter Aortic Valve Implantation

Augmented Reality System for Ultrasound Guidance of Transcatheter Aortic Valve Implantation

Augmented Reality Image Guidance Improves Navigation for Beating Heart Mitral Valve Repair

Phantom study of an ultrasound guidance system for transcatheter aortic valve implantation

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