Framework for Planning TMVR using 3-D Imaging, In Silico Modeling, and Virtual Reality

Kohli, Keshav; Wei, Zhenglun Alan; Sadri, Vahid; Easley, Thomas F.; Pierce, Eric T.; Zhang, Yingnan Nancy; Wang, Dee Dee; Greenbaum, Adam; Lisko, John; Khan, Jaffar; Lederman, Robert J.; Blanke, Philipp; Oshinski, John N.; Babaliaros, Vasilis; Yoganathan, Ajit P.

doi:10.1080/24748706.2020.1762268

Cited by 5 publications

(5 citation statements)

References 2 publications

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“…Despite recent generic reviews of visual computing solutions in cardiology applications[ 2 , 4 - 6 ], there is a lack of complete studies testing the different visualization methodologies on the same patient-specific data for benchmarking purposes. To the best of our knowledge, our study is the first attempt on this direction focusing on LAAO interventions, aiming at evaluating the added value, limitations, and requirements for the clinical translation of these technologies.…”

Section: Discussionmentioning

confidence: 99%

“…At this juncture, there is a significant gap in understanding the 3D (plus time) anatomical and physiological relationships in the heart[ 3 ] that visual computing solutions can help to bridge. Recent studies have reviewed the added value of advanced visualization of cardiac data, including applications in conditions such as congenital heart disease[ 4 , 5 ], structural heart disease[ 2 ], or transcatheter mitral valve replacement[ 6 ].…”

Section: Introductionmentioning

confidence: 99%

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Domain expert evaluation of advanced visual computing solutions and 3D printing for the planning of the left atrial appendage occluder interventions

Mill¹,

Montoliu²,

Moustafa³

et al. 2022

ijb

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Advanced visual computing solutions and three-dimensional (3D) printing are moving from engineering to clinical pipelines for training, planning, and guidance of complex interventions. 3D imaging and rendering, virtual reality (VR), and in-silico simulations, as well as 3D printing technologies provide complementary information to better understand the structure and function of the organs, thereby improving and personalizing clinical decisions. In this study, we evaluated several advanced visual computing solutions, such as web-based 3D imaging visualization, VR, and computational fluid simulations, together with 3D printing, for the planning of the left atrial appendage occluder (LAAO) device implantations. Six cardiologists tested different technologies in pre-operative data of five patients to identify the usability, limitations, and requirements for the clinical translation of each technology through a qualitative questionnaire. The obtained results demonstrate the potential impact of advanced visual computing solutions and 3D printing to improve the planning of LAAO interventions as well as the need for their integration into a single workflow to be used in a clinical environment.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Domain expert evaluation of advanced visual computing solutions and 3D printing for the planning of the left atrial appendage occluder interventions

Mill¹,

Montoliu²,

Moustafa³

et al. 2022

ijb

View full text Add to dashboard Cite

show abstract

“…However, the clinical translation of advanced visualisation technologies is not straightforward, fulfilling the demanding requirements to be embedded in the existing workflows in hospitals. Despite recent generic reviews of visual computing solutions in cardiology applications (e.g., Wang et al (2021); Salavitabar et al (2020); Goo et al (2020); Kohli et al (2020)), there is a lack of complete studies testing the different visualisation methodologies on the same patient-specific data for benchmarking purposes. To the best of our knowledge, our study is the first attempt on this direction focused on LAAO interventions, aiming at evaluating the added value, limitations and requirements for the clinical translation of these technologies.…”

Section: Discussionmentioning

confidence: 99%

“…At this juncture, there is a significant gap in understanding the 3D (plus time) anatomical and physiological relationships in the heart Wang et al (2018a) that visual computing solutions can help to bridge. Recent studies have reviewed the added value of advanced visualisation of cardiac data, including in specific applications such as in congenital heart disease Salavitabar et al (2020); Goo et al (2020), in structural heart disease Wang et al (2021) or transcatheter mitral valve replacement Kohli et al (2020).…”

Section: Introductionmentioning

confidence: 99%

Domain expert evaluation of advanced visual computing solutions for the planning of left atrial appendage occluder interventions

Mill¹,

Montoliu²,

Moustafa

et al. 2022

Preprint

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Advanced visual computing solutions and 3D printing are starting to move from the engineering and development stage to being integrated into clinical pipelines for training, planning and guidance of complex interventions. Commonly, clinicians make decisions based on the exploration of patient-specific medical images in 2D flat monitors using specialised software with standard multi-planar reconstruction (MPR) visualisation. The new generation of visual computing technologies such as 3D imaging, 3D printing, 3D advanced rendering, Virtual Reality and in-silico simulations from Virtual Physiological Human models, provide complementary ways to better understand the structure and function of the organs under study and improve and personalise clinical decisions. Cardiology is a medical field where new visual computing solutions are already having an impact in decisions such as the selection of the optimal therapy for a given patient. A good example is the role of emerging visualisation technologies to choose the most appropriate settings of a left atrial appendage occluder (LAAO) device that needs to be implanted in some patients with atrial fibrillation having contraindications to drug therapies. Clinicians need to select the type and size of the LAAO device to implant, as well as the location to be deployed. Usually, interventional cardiologists make these decisions after the analysis of patient-specific medical images in 2D flat monitors with MPR visualisation, before and during the procedure, obtain manual measurements characterising the cardiac anatomy of the patient to avoid adverse events after the implantation. In this paper we evaluate several advanced visual computing solutions such as web-based 3D imaging visualisation (VIDAA platform), Virtual Reality (VRIDAA platform) and computational fluid simulations and 3D printing for the planning of LAAO device implantations. Six physicians including three interventional and three imaging cardiologists, with different level of experience in LAAO, tested the different technologies in preoperative data of 5 patients to identify the usability, friendliness, limitations and requirements for clinical translation of each technology through a qualitative questionnaire. The obtained results demonstrate the potential impact of advanced visual computing solutions to improve the planning of LAAO interventions but also a need of unification of them in order to be able to be uses in a clinical environment.

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“…These data suggests that, in patients undergoing a valve-in-ring or valve-in-mitral annular calcification procedure, the anticipated risk of obstruction may in fact differ from the actual risk based on factors such as valve deployment depth (more atrial vs. more ventricular) or the valve deployment orientation (coaxial vs. canted with respect to the mitral valve). Personalized computational modeling may eventually help in better predicting the hemodynamic outcome of patients ( 13 ), and should account for a range of valve deployment scenarios. Recent interventional techniques have also enabled more predictable deployment of the transcatheter valve in the predicted landing zone, and may help improve future predictions of LVOT obstruction risk ( 14 , 15 ).…”

Section: Discussionmentioning

confidence: 99%

Assessing the Hemodynamic Impact of Anterior Leaflet Laceration in Transcatheter Mitral Valve Replacement: An in silico Study

Kohli

Wei

Sadri

et al. 2022

Front. Cardiovasc. Med.

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BackgroundA clinical study comparing the hemodynamic outcomes of transcatheter mitral valve replacement (TMVR) with vs. without Laceration of the Anterior Mitral leaflet to Prevent Outflow Obstruction (LAMPOON) has never been designed nor conducted.AimsTo quantify the hemodynamic impact of LAMPOON in TMVR using patient-specific computational (in silico) models.MaterialsEight subjects from the LAMPOON investigational device exemption trial were included who had acceptable computed tomography (CT) data for analysis. All subjects were anticipated to be at prohibitive risk of left ventricular outflow tract (LVOT) obstruction from TMVR, and underwent successful LAMPOON immediately followed by TMVR. Using post-procedure CT scans, two 3D anatomical models were created for each subject: (1) TMVR with LAMPOON (performed procedure), and (2) TMVR without LAMPOON (virtual control). A validated computational fluid dynamics (CFD) paradigm was then used to simulate the hemodynamic outcomes for each condition.ResultsLAMPOON exposed on average 2 ± 0.6 transcatheter valve cells (70 ± 20 mm2 total increase in outflow area) which provided an additional pathway for flow into the LVOT. As compared to TMVR without LAMPOON, TMVR with LAMPOON resulted in lower peak LVOT velocity, lower peak LVOT gradient, and higher peak LVOT effective orifice area by 0.4 ± 0.3 m/s (14 ± 7% improvement, p = 0.006), 7.6 ± 10.9 mmHg (31 ± 17% improvement, p = 0.01), and 0.2 ± 0.1 cm2 (17 ± 9% improvement, p = 0.002), respectively.ConclusionThis was the first study to permit a quantitative, patient-specific comparison of LVOT hemodynamics following TMVR with and without LAMPOON. The LAMPOON procedure achieved a critical increment in outflow area which was effective for improving LVOT hemodynamics, particularly for subjects with a small neo-left ventricular outflow tract (neo-LVOT).

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Framework for Planning TMVR using 3-D Imaging, In Silico Modeling, and Virtual Reality

Cited by 5 publications

References 2 publications

Domain expert evaluation of advanced visual computing solutions and 3D printing for the planning of the left atrial appendage occluder interventions

Domain expert evaluation of advanced visual computing solutions and 3D printing for the planning of the left atrial appendage occluder interventions

Domain expert evaluation of advanced visual computing solutions for the planning of left atrial appendage occluder interventions

Assessing the Hemodynamic Impact of Anterior Leaflet Laceration in Transcatheter Mitral Valve Replacement: An in silico Study

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