Safety and efficacy of transseptal puncture guided by real-time fusion of echocardiography and fluoroscopy

Abstract

AimsVisual guidance through echocardiography and fluoroscopy is crucial for a successful transseptal puncture (TSP) in a prespecified region of the fossa ovalis. The novel EchoNavigator system Release II (EchoNav II, Philips Healthcare, Andover, Massachusetts, USA) enables the real-time fusion of fluoroscopic and echocardiographic images. We evaluated this new imaging method in respect to safety and efficacy of TSP during MitraClip implantation and left atrial appendage closure.MethodsForty-four patients before (−EchoNav) and 44 patients after (+EchoNav) the introduction of real-time fusion were included in our retrospective, single-centre study. The primary endpoint was the occurrence of adverse events due to TSP. Secondary endpoints were successful puncture at the prespecified region and time until TSP (min).ResultsIn both groups TSP was performed successfully in the prespecified region and no adverse events occurred during or due to the accomplishment of TSP. Time until TSP was significantly reduced in the +EchoNav group in comparison with the EchoNav group (18.48 ± 5.62 min vs. 23.20 ± 9.61 min, p = 0.006).ConclusionsReal-time fusion of echocardiography and fluoroscopy proved to be as safe and successful as standard best practice for TSP. Moreover, efficacy was improved through significant reduction of time until TSP.

Echocardiography–fluoroscopy fusion imaging: The essential features used in congenital and structural heart disease interventional guidance

“…The transseptal puncture is a preparatory step for access to the left heart in structural heart disease interventions such as MitraClip, perivalvular leak (PVL) closures, and left atrial appendage (LAA) occlusion 12,20 . 3D TEE provides an en face view of the atrial septum and other soft tissue anatomy.…”

“…The “tenting” in orthogonal position is critical for correct placement of the puncture site. A real time overlay of 3D anatomic rendering of chamber structures on fluoroscopy has been used for evaluation of transseptal puncture in MitraClip and left atrial appendage occlusions 12,13 …”

“…By registering the TEE probe with fluoroscopy, the interventionalists can manipulate the 3D TEE images in the same way as fluoroscopy, facilitating complex procedural guidance. EFF imaging decreases fluoroscopic time and total radiation dose in interventional procedures as in pediatric ASD closures, adult left atrial appendage closures, and transseptal puncture in mitral clip interventions 4,11−14 …”

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

“…EchoNavigator has shown to be a safe method to guide TSP and significantly decreases the duration to perform TSP (18.48 ± 5.62 vs. 23.20 ± 9.61 min, p = 0.006). 35 …”

Echo-navigation to guide challenging transseptal puncture during transfemoral repair of mitral and tricuspid valve

“…The complementary use of EchoNavigator may help to overcome the intrinsic imaging limitations of the interatrial septum, whereas the fiducial markers increase tremendously the chance of procedural success. [1][2][3]…”