ORIGINAL ARTICLE  CARDIAC SECTION 

The Journal of Cardiovascular Surgery 2018 February;59(1):111-4

DOI: 10.23736/S0021-9509.17.10095-9

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

Feasibility and applicability of static vascular outline roadmapping during transcatheter aortic valve implantation

Navid MADERSHAHIAN ¹, Carolyn WEBER ¹ ✉, Payman MAJD ², Tanja RUDOLPH ³, Elmar KUHN ¹, Maximilian SCHERNER ⁴, Yeong-Hoon CHOI ¹, Kaveh EGHBALZADEH ¹, Volker RUDOLPH ³, Cherif SAHYOUN ⁵, Thorsten WAHLERS ¹

¹ Department of Cardiac and Thoracic Surgery, University Hospital of Cologne, Cologne, Germany; ² Department of Vascular Surgery, University Hospital of Cologne, Cologne, Germany; ³ Department of Internal Medicine III, University Hospital of Cologne, Cologne, Germany; ⁴ University Hospital of Magdeburg, Magdeburg, Germany; ⁵ Philips Healthcare, Best, The Netherlands

BACKGROUND: We investigated the application and feasibility of a novel software tool designed for the visualization of the aortic root during transcatheter aortic valve implantation (TAVI). The final positioning of the device prior deployment remains the most critical phase during TAVI.
METHODS: Philips “Vascular Outlining” prototype application was used during balloon expandable Edwards Lifesciences SapienXT valve deployment. It processes any angiographic sequences, extracting the static outline of vessels and projecting the two-dimensional vessel margins as a roadmap on live fluoroscopy. Preoperational planning, sizing and anatomical assessment of access routes were performed using computed tomography scans and the Philips “HeartNavigator” software.
RESULTS: Fifteen high-risk aortic stenosis patients (mean age 82.0±6.6 years) underwent TAVI via transfemoral (N.=8), transapical (N.=4), and transaortic (N.=3) access routes. Mean logistic EuroSCOREs and STS-scores were 19.7±4.3% and 7.9±3.1%, respectively, mean aortic gradient was 66.3±18.3 mmHg. All valves were implanted successfully with none or trivial paravalvular regurgitation in 11 patients, mild in 3 patients, and moderate in 1 patient. TAVI was performed in all cases with only one aortic root contrast media injection during valve deployment. No major stroke or cardiovascular death occurred within 30 days.
CONCLUSIONS: “Vascular Outlining”-guided implantation of the SapienXT valve is feasible. This new feature might increase the accuracy of valve placement and also may reduce the need for extra contrast media use during valve deployment. However, the lack of real-time motion compensation limits its wide application, as the overlay does not move together with respiratory and cardiac motion.

KEY WORDS: Transcatheter aortic valve replacement - Aortic valve stenosis - Software