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DOI: 10.1055/s-0029-1246838
Perioperative DynaCT for improved imaging during transcatheter aortic valve implantation
Objective: Transcatheter aortic valve implantation (AVI) requires optimal positioning and is routinely being performed under fluoroscopic, angiographic and echocardiographic imaging only. Improved imaging techniques, such as three dimensional reconstruction and placement of additional landmarks (“line-concept“) may be helpful.
Methods: DynaCT was performed in 15 patients during routine transapical AVI using an Axiom Artis imaging system (Siemens Healthcare, Forchheim, Germany) in a hybrid operative theatre. DynaCT consisted of rotational angiography performed under rapid ventricular pacing with diluted contrast (25cc), three dimensional reconstruction of the aortic root, prototype automatic segmentation and detection of landmarks. No further registration was required.
Results: All patients were implanted in an overlay mode. Automatic detection of landmarks (coronary ostia and aortic sinuses) was perfect in 13 and acceptable in 2 patients. Exact perpendicular angulation was achieved in 12 and acceptable angulation in 3 patients. Deviation of the coronary ostium in relation to the angiographic standard was 2.1±0.14mm. All valves were safely implanted intraannularly with the additional guidance of the landmark lines.
Fig. DynaCT
Conclusion: DynaCT guided angulation of the C-arm and valve implantation using landmarks is a valuable and helpful tool to improve the precision of TA-AVI and thus enhance patient safety.