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Simulated prosthesis overlay for patient-specific planning of transcatheter aortic valve implantation procedures


Sündermann, Simon H; Gessat, Michael; Maier, Willibald; Kempfert, Jörg; Frauenfelder, Thomas; Nguyen, Thi D L; Maisano, Francesco; Falk, Volkmar (2015). Simulated prosthesis overlay for patient-specific planning of transcatheter aortic valve implantation procedures. Innovations : Technology And Techniques In Cardiothoracic And Vascular Surgery, 10(5):314-322.

Abstract

OBJECTIVE: We tested the hypothesis that simulated three-dimensional prosthesis overlay procedure planning may support valve selection in transcatheter aortic valve implantation (TAVI) procedures.
METHODS: Preoperative multidimensional computed tomography (MDCT) data sets from 81 consecutive TAVI patients were included in the study. A planning tool was developed, which semiautomatically creates a three-dimensional model of the aortic root from these data. Three-dimensional templates of the commonly used TAVI implants are spatially registered with the patient data and presented as graphic overlay. Fourteen physicians used the tool to perform retrospective planning of TAVI procedures. Results of prosthesis sizing were compared with the prosthesis size used in the actually performed procedure, and the patients were accordingly divided into three groups: those with equal size (concordance with retrospective planning), oversizing (retrospective planning of a smaller prosthesis), and undersizing (retrospective planning of a larger prosthesis).
RESULTS: In the oversizing group, 85% of the patients had new pacemaker implantation. In the undersizing group, in 66%, at least mild paravalvular leakage was observed (greater than grade 1 in one third of the cases). In 46% of the patients in the equal-size group, neither of these complications was observed.
CONCLUSIONS: Three-dimensional prosthesis overlay in MDCT-derived patient data for patient-specific planning of TAVI procedures is feasible. It may improve valve selection compared with two-dimensional MDCT planning and thus yield better outcomes.

Abstract

OBJECTIVE: We tested the hypothesis that simulated three-dimensional prosthesis overlay procedure planning may support valve selection in transcatheter aortic valve implantation (TAVI) procedures.
METHODS: Preoperative multidimensional computed tomography (MDCT) data sets from 81 consecutive TAVI patients were included in the study. A planning tool was developed, which semiautomatically creates a three-dimensional model of the aortic root from these data. Three-dimensional templates of the commonly used TAVI implants are spatially registered with the patient data and presented as graphic overlay. Fourteen physicians used the tool to perform retrospective planning of TAVI procedures. Results of prosthesis sizing were compared with the prosthesis size used in the actually performed procedure, and the patients were accordingly divided into three groups: those with equal size (concordance with retrospective planning), oversizing (retrospective planning of a smaller prosthesis), and undersizing (retrospective planning of a larger prosthesis).
RESULTS: In the oversizing group, 85% of the patients had new pacemaker implantation. In the undersizing group, in 66%, at least mild paravalvular leakage was observed (greater than grade 1 in one third of the cases). In 46% of the patients in the equal-size group, neither of these complications was observed.
CONCLUSIONS: Three-dimensional prosthesis overlay in MDCT-derived patient data for patient-specific planning of TAVI procedures is feasible. It may improve valve selection compared with two-dimensional MDCT planning and thus yield better outcomes.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Cardiovascular Surgery
04 Faculty of Medicine > University Hospital Zurich > Clinic for Diagnostic and Interventional Radiology
Dewey Decimal Classification:610 Medicine & health
Uncontrolled Keywords:Heart valve, transapical approach, Computed tomography imaging, 3D modeling, Transcatheter aortic valve replacement
Language:English
Date:2015
Deposited On:11 Dec 2015 13:18
Last Modified:08 Dec 2017 15:25
Publisher:Lippincott Williams & Wilkins
ISSN:1556-9845
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.1097/IMI.0000000000000198
PubMed ID:26575379

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