Echocardiographic-fluoroscopic fusion imaging for transcatheter mitral valve repair guidance

Faletra, Francesco F.; Pozzoli, Alberto; Agricola, Eustachio; Guidotti, Andrea; Biasco, Luigi; Leo, Laura Anna; Taramasso, Maurizio; Pasotti, Elena; Kuwata, Shingo; Moscarelli, Marco; Tanner, Felix C.; Pedrazzini, Giovanni; Nietlispach, Fabiàn; Moccetti, Tiziano; Züber, Michel

doi:10.1093/ehjci/jey067

Cited by 42 publications

(22 citation statements)

References 22 publications

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“…However, as treatment focus shifts to include MitraClip for secondary MR in patients with compromised left ventricular function, mild–moderate pulmonary hypertension, multi‐valvular heart disease, etc., steps to minimize overall procedure time will be critical to ensuring programmatic success. Furthermore, there are increasing experience with “fusion” imaging whereby fluoroscopy is coupled with noninvasive imaging for MitraClip and other structural heart therapies 17 . As with the use of adjunctive fluoroscopy technique in this manuscript, the relative impact of increased fluoroscopy time and increased radiation exposure will have to be weighed against the benefit of improved procedural outcomes and increased procedural efficiencies.…”

Section: Discussionmentioning

confidence: 99%

Adjunctive use of fluoroscopy during MitraClip implantation reduces procedural complexity: The parallax technique

Singh

Rogers

Chen

et al. 2020

Cathet Cardio Intervent

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Background During MitraClip implantation sub‐valvular correction of trajectory and/or alignment may increase adverse clip or leaflet events. With systematic adjunctive use of fluoroscopy (“Parallax technique”), we aimed to assess parameters that minimize the need for corrective measures and help increase procedural efficiency. Methods We retrospectively analyzed 30 patients without (Fl‐) and 39 patients utilizing adjunctive fluoroscopy (Fl+) during MitraClip implantation. After establishing trajectory and supra‐valvular alignment, the Parallax technique was utilized. Trajectory and alignment are maintained during advancement. Results All patients had 3 or 4+ MR. There were no differences in baseline demographics. The average number of clips (Fl‐ vs Fl+) was 1.72 ± 0.8 vs 1.59 ± 0.5, p = .57. For the first clip, the need for sub‐valvular alignment (80% vs. 36%, p = .0001), eversion with retraction back to left atrium (23% vs. 10%, p = .001) and the number of grasps (2.3 ± 1.2 vs 1.4 ± 0.9) was reduced. The time from transseptal puncture to first clip deployment (71 ± 21 vs 44 ± 16 min, p = .01) was reduced. Procedural success was achieved in all but one patient in the Fl‐ group (p = ns). There were no differences noted for in‐hospital or 30‐day outcomes. Conclusions Systematic use of a simple and easy to implement “Parallax technique” was associated with reduced need for sub‐valvular manipulation and was associated with improved procedural times. Further larger scale studies are needed to assess the applicability of the technique.

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Section: Discussionmentioning

confidence: 99%

Adjunctive use of fluoroscopy during MitraClip implantation reduces procedural complexity: The parallax technique

Singh

Rogers

Chen

et al. 2020

Cathet Cardio Intervent

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“…An expert consensus statement on core competencies in echocardiography for imaging in structural heart disease interventions published recently emphasizes the need for a distinct educational training pathway for interventional echocardiography specialists, being a fully integrated part of the procedural team to facilitate optimal results 14 . Furthermore, availability of real time fusion imaging (integration of TEE or CT in fluoroscopic visualization) has enriched advanced guidance for transcatheter structural heart interventions (eg, 15,16 ). Nevertheless, implementation of MPR in 3DTEE might be the key to optimal true axis visualization of soft tissue structures in the context of these contemporary developments.…”

Section: Discussionmentioning

confidence: 99%

Feasibility of a MPR‐based 3DTEE guidance protocol for transcatheter direct mitral valve annuloplasty

et al. 2020

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Objectives Several interventional approaches have been established for the treatment of severe mitral regurgitation (MR) in patients at elevated risk for surgery. Direct annuloplasty is a relatively novel option in transcatheter mitral valve repair dedicated to reverse pathology in specific subsets of MR. With regard to echocardiographic guidance, this procedure presents with higher efforts in comparison with edge‐to‐edge therapy to enable safe and exact positioning of the device's anchors; evidence on optimal peri‐interventional imaging is sparse. We tested a specific 3D‐echo‐guidance protocol implementing single‐beat multiplanar reconstruction (MPR) and evaluated its feasibility. Methods Overall, 16 patients consecutively treated with transcatheter direct annuloplasty for severe MR (87.5% functional/6.3% degenerative/6.3% mixed pathology) were entered in this monocentric analysis. Of these, two patients received a combined procedure including edge‐to‐edge repair. For all implantations, a 3D‐echo‐guidance protocol inheriting MPR was employed. Results Periprocedural device time decreased continuously (overall mean 140 ± 55.1 minutes, 213 ± 38 minutes in the first 4 vs 108 ± 33 minutes in the last 4 procedures, P = .018) using the MPR‐based echo protocol, going along with reduced fluoroscopy times and doses. Technical success rate was high (93.8%) without any serious cardiac‐related adverse events. MR could be relevantly improved. Conclusion Echocardiographic guidance of transcatheter direct annuloplasty using a real time MPR‐based protocol is feasible and safe. Optimized imaging might enable reduced implantation times and potentially increases safety.

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“…CT and fluoroscopic fusion imaging have also been applied to LAA occlusion 5 . Intraprocedural TEE and fluoroscopy can also be fused to allow 3D visualization of cardiac anatomy for a number of different procedures including perivalvular leak closure, MitraClip (Abbott Laboratories), and Cardioband (Edwards Lifesciences) 6 . Recently, TEE and fluoroscopic fusion has been reported for LAA occlusion with the Amulet device (Abbott Laboratories) 7 .…”

Section: Discussionmentioning

confidence: 99%

Novel use of fused cardiac computed tomography and transesophageal echocardiography for left atrial appendage closure

Peters

Motiwala

O’Neill

et al. 2020

Cathet Cardio Intervent

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The use of the Watchman left atrial appendage occlusion device (Boston Scientific Inc.) is becoming increasingly frequent in patients with atrial fibrillation. Cardiac computed tomography (CT) for device sizing pre‐procedure can help facilitate more accurate device selection compared with transesophageal echo (TEE) alone. CT can also help identify minor lobes and trabeculations that may not be apparent on TEE. We report a series of three cases to highlight the utility of a novel application of CT‐TEE fusion imaging to provide procedural guidance during Watchman implant and to assess for peri‐device leak post‐implant.

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Echocardiographic-fluoroscopic fusion imaging for transcatheter mitral valve repair guidance

Cited by 42 publications

References 22 publications

Adjunctive use of fluoroscopy during MitraClip implantation reduces procedural complexity: The parallax technique

Adjunctive use of fluoroscopy during MitraClip implantation reduces procedural complexity: The parallax technique

Feasibility of a MPR‐based 3DTEE guidance protocol for transcatheter direct mitral valve annuloplasty

Novel use of fused cardiac computed tomography and transesophageal echocardiography for left atrial appendage closure

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