Clinical utility of intraprocedural three‐dimensional integrated image guided transcatheter aortic valve implantation using novel automated computed tomography software: A single‐center preliminary experience

Abstract

Objectives Novel automated computed tomography (CT) software (Valve ASSIST 2) has been developed for transcatheter aortic valve implantation (TAVI), which not only provides three‐dimensional (3D) reconstruction of multidetector (MD) CT images, but also enables intraprocedural real‐time fusion of fluoroscopic and MDCT images. We aimed to clarify the reproducibility and accuracy of this software in the aortic annulus assessment and verify the potential of intraprocedural integrated MDCT imaging for TAVI. Methods and results We examined 50 patients with severe aortic stenosis undergoing transfemoral TAVI. Aortic annulus measurements were performed using 3mensio and the novel planning software. For intraprocedural imaging, preoperative CT dataset was overlaid onto fluoroscopy with the fusion software. The two images were aligned using the aortic root anatomy visible on both modalities. Novel planning software provided excellent reproducibility for the measurement of aortic annulus area (intraobserver intraclass correlation coefficients [ICC] 0.959, interobserver ICC 0.941), and perimeter (intraobserver ICC 0.915, interobserver ICC 0.912). Excellent correlation was found between novel planning software and 3mensio (ICC 0.952 for aortic annulus area, and 0.923 for perimeter). Intraprocedural fusion image of CT aortography and fluoroscopic aortic root aortography generated by this novel software identified coronary orifices and the distribution of aortic valve calcification during the device positioning. Fusion image displayed coronary orifices after device implantation. Conclusions Novel planning software showed excellent reproducibility and accuracy in the assessment of aortic root anatomy. Furthermore, the integrated 3D fusion image might have a potential as an intraprocedural imaging modality to contribute to the development of a safer TAVI procedure.

Position-based dynamics simulator of vessel deformations for path planning in robotic endovascular catheterization

“…Deformable vessels with AR provide 3D visualization to help guide and locate the instrument more intuitively. Clinical studies in [49] highlight the need for intra-operative 3D visualization to help develop safer interventions. Several commercial systems, such as EnSite NavX (St.Jude), Carto (Biosense Webster), and LocaLisa (Medtronic), develop AR techniques as an alternative to classical imaging techniques.…”

First use of 3D-TEE model-based fully automatic fusion of 3D-MSCT and fluoroscopy during transcatheter aortic valve implantation

“…Several tools have been developed in order to optimise transcatheter aortic valve implantation (TAVI) procedures and decrease the risk of procedural complications such as acute kidney injury. Real-time fusion of 3D multislice computed tomography (3D-MSCT) images with X-ray fluoroscopy may help physicians during the procedure 1 . However, these still MSCT images cannot be matched with X-ray fluoroscopy without the use of contrast injection 1 .…”

“…Real-time fusion of 3D multislice computed tomography (3D-MSCT) images with X-ray fluoroscopy may help physicians during the procedure 1 . However, these still MSCT images cannot be matched with X-ray fluoroscopy without the use of contrast injection 1 . We describe the first use of a new, fully automatic, 3D transoesophageal echocardiography (TEE)-based fusion technique of 3D-MSCT on live fluoroscopy during TAVI.…”

Model-to-Image Registration via Deep Learning towards Image-Guided Endovascular Interventions

“…Nevertheless, that 2D image does not provide enough information for cardiologists, and the need for an intra-operative 3D visualization is highlighted. For example, the clinical study in [3] stressed that image fusion could help cardiologists for performing TAVI procedures and validated it through controlled experiments. The fusion image of the aortic root is presented intra-operatively under the support of the Valve ASSIST 2 (GE Healthcare), which is registered at the beginning of the procedure from multiple fluoroscopy views.…”