Belhaj Soulami Réda, Verhoye Jean-Philippe, Nguyen Duc Hung, Castro Miguel, Auffret Vincent, Anselmi Amedeo, Haigron Pascal, Ruggieri Vito Giovanni
From the *Department of Thoracic and Cardio-Vascular Surgery, Pontchaillou University Hospital, Rennes, France; †LTSI Laboratory, INSERM 1099U, Rennes 1 University, Rennes, France; and ‡Department of Cardiology, Pontchaillou University Hospital, Rennes, France.
Innovations (Phila). 2016 May-Jun;11(3):193-200. doi: 10.1097/IMI.0000000000000259.
Valve-in-valve (ViV) procedures are increasingly being considered as an alternative to redo surgery for the treatment of degenerated bioprosthetic heart valves in patients with excessive reoperative risk. The objective of our study was to evaluate the feasibility of computer guidance in transcatheter heart valve (THV) implantation during ViV procedures.
Preprocedural electrocardiogram-gated computed tomography-scan images were processed using semiautomatic segmentation of the degenerated bioprosthesis' radiopaque landmarks and of the ascending aorta. Virtual three-dimensional (3D) reconstructions were created. A virtual plane was subsequently added to the 3D reconstructions, indicating the optimal landing plane of the THV inside the tissue valve. Within a hybrid operating theater, a 3D/2D registration was used to superimpose the 3D reconstructions, while dynamic tracking was allowed to maintain the superimposition onto the fluoroscopic images. The THV was afterward implanted according to the optimal landing plane. Projection of the ascending aorta and the coronary arteries was used to assess the risk of coronary ostia obstruction.
Between January 2014 and October 2014, nine patients underwent aortic ViV procedures in our institution. Among those nine patients, five procedures were retrospectively evaluated as a validation step using the proposed method. The mean (SD) superimposition error was 1.1 (0.75) mm. Subsequently, two live cases were prospectively carried out using our approach, successfully implanting the THV inside the degenerated tissue valve.
Our study demonstrates the feasibility of a computer-guided implantation of THV in ViV procedures. Moreover, it suggests that augmented reality may increase the reliability of THV implantation inside degenerated bioprostheses through better reproducibility.
对于再次手术风险过高的患者，瓣中瓣（ViV）手术越来越被视为治疗退化生物人工心脏瓣膜的再次手术替代方案。我们研究的目的是评估计算机引导在ViV手术经导管心脏瓣膜（THV）植入中的可行性。
术前使用退化生物假体的不透射线标志和升主动脉的半自动分割处理心电图门控计算机断层扫描图像。创建虚拟三维（3D）重建。随后在3D重建中添加一个虚拟平面，指示THV在组织瓣膜内的最佳着陆平面。在混合手术室中，使用3D/2D配准来叠加3D重建，同时允许动态跟踪以保持叠加在荧光透视图像上。然后根据最佳着陆平面植入THV。利用升主动脉和冠状动脉的投影评估冠状动脉口阻塞的风险。
2014年1月至2014年10月期间，我院有9例患者接受了主动脉ViV手术。在这9例患者中，有5例手术使用所提出的方法进行回顾性评估作为验证步骤。平均（标准差）叠加误差为1.1（0.75）mm。随后，前瞻性地使用我们的方法进行了2例实际病例，成功地将THV植入退化的组织瓣膜内。
我们的研究证明了计算机引导在ViV手术中植入THV的可行性。此外，这表明增强现实可能通过更好的可重复性提高在退化生物假体中植入THV的可靠性。
