Page 12 - Journal of Structural Heart Disease Volume 4, Issue 5

New Technology
Journal of Structural Heart Disease, October 2018, Volume 4, Issue 5:207-211
DOI: https://doi.org/10.12945/j.jshd.2018.050.17
Received: December 19, 2017 Accepted: January 28, 2018 Published online: October 2018
Feasibility of Fully Automated Motion Compensated Overlay for Transcatheter Aortic Valve Implantation
Nick Assink, MSc1, Maria-Louisa Izamis, PhD2, Olivier Nempont, PhD3, Marco Verstege, PDEng1, Cherif P. Sahyoun, PhD1, Alexander Haak, PhD1, John D. Carroll, MD4, John C. Messenger, MD4, Gerhard Schymik, MD5, Navid Madershahian, MD6, Thorsten C. Wahlers, MD6, Peter Eshuis, PhD,1*
1 Philips Healthcare, Best, The Netherlands
2 Philips Research, Eindhoven, The Netherlands
3 Philips Research, Paris, France
4 Division of Cardiology, University of Colorado Hospital, Aurora, Colorado, USA
5 Municipal Hospital Karlsruhe, Karlsruhe, Germany
6 Department of Cardiac and Thoracic Surgery, Cologne University Heart Center, Cologne, Germany
Abstract
Background: Automated motion compensation of aor- tic root overlay on fluoroscopy during transcatheter aortic valve implantation (TAVI) could ensure accurate device positioning at minimal contrast cost, thereby re- ducing complication rates.
Objectives: To describe the feasibility of software that automatically compensates for cardiac and respiratory motion on X-ray, which may allow greater device con- trol during TAVI.
Methods: Twenty four TAVI cases (25,607 frames) from four independent institutions using either the Medtronic CoreValve (n=8) or Edwards Sapien valve (n=16) were post-processed with the software. For each case, the algorithm applied three steps: (i) Generation of an anatomical roadmap using X-ray (Vascular Out- lining, or VO) or 3D segmentation of CT data, (ii) Cor- relation to pigtail catheter, and (iii) Real-time motion compensation.
Results: VO motion compensation was activated 84% of all frames yielding a relative displacement error of -1.09 ± 2.65 mm. Similarly, CT-aided motion compen- sation was activated 84% of frames yielding a relative displacement error of -0.77 ± 2.92 mm.
Conclusions: We have shown feasibility of the first fully automated motion compensation method for real-time continuous visualization of the target aortic anatomy during TAVI procedures. Our method has the potential to improve valve positioning accuracy and reduction in deployment variability.
Copyright © 2018 Science International Corp.
Key Words
Aortic stenosis • TAVI • TAVR • Imaging modalities • Non- invasive imaging
Introduction
With over 250,000 procedures conducted world- wide in the last decade, transcatheter aortic valve im- plantation (TAVI) has gained widespread acceptance for the treatment of aortic valve disease [1]. As out- comes continue to improve, TAVI is expected to be performed in younger, lower-risk patients [2] and will grow the number of procedures further. Correct posi- tioning of the artificial valve is crucial for TAVI outcome [3]. Current implantation of prosthetic aortic valves
* Corresponding Author:
Peter Eshuis, PhD
Philips Healthcare
Veenpluis 6, 5684 PC Best, The Netherlands
Tel. +31 (0)40 2763681; E-Mail: peter.g.eshuis@philips.com
Fax +1 203 785 3346
E-Mail: jshd@scienceinternational.org http://structuralheartdisease.org/
© 2018 Journal of Structural Heart Disease Published by Science International Corp. ISN 2326-4004
Accessible online at:
http://structuralheartdisease.org/