Roy A K, Horvilleur J, Cormier B, Cazalas M, Fernandez L, Patane M, Neylon A, Spaziano M, Sawaya F J, Arai T, Bouvier E, Hovasse T, Lefèvre T, Chevalier B, Garot P
Institut Cardiovasculaire Paris-Sud, Massy, France, Ramsay-Générale de Santé, Paris, France.
General Electric Company, Buc, France.
Catheter Cardiovasc Interv. 2018 Feb 1;91(2):322-329. doi: 10.1002/ccd.26998. Epub 2017 Mar 17.
This report demonstrates the application and feasibility of novel 3D-MDCT real-time fusion technology with fluoroscopy, for left atrial appendage (LAA) occlusion procedures.
A successful LAA occlusion procedure relies on multiple imaging modalities, including TEE or 3D-MDCT, and fluoroscopy. Effectively integrating these imaging modalities may improve implantation safety and success. To our knowledge this technique has not been previously described for LAA occlusions.
This observational study compared clinical and procedural parameters for procedures performed with or without fusion integration. All patients had a pre-procedural 3D-MDCT for LAA measurements, along with 3D analyses of LAA morphology and surrounding structures. Using the image fusion software (Valve ASSIST 2, GE Healthcare, UK), landmarks were identified on fluoroscopy, and MDCT LAA anatomy outlines were then projected onto the real-time fluoroscopy image during the procedure, to guide all steps of the intervention.
A total of 57 patients underwent LAA occlusion, with 16 performed using fusion software. In comparison to the pre-fusion group, reductions in contrast volume (21.0 ± 11.7 vs. 95.9 ± 80.5 ml, P < 0.001), procedure time (63.0 ± 22.0 vs. 87.3 ± 43.0 min, P = 0.01), and fluoroscopy time (6.2 vs. 8.3 min, P = 0.03) were observed. Incomplete sealing (0 vs. 14.6%, P = 0.16) and device deployment success (100 vs. 92.7%, P = 0.17) were not significantly different.
The addition of this novel fusion technology is safe and feasible. To optimize LAA procedural success, fusion integration may offer a promising addition, or alternative, to current imaging modalities. © 2017 Wiley Periodicals, Inc.
本报告展示了新型3D-MDCT与荧光透视实时融合技术在左心耳（LAA）封堵手术中的应用及可行性。
成功的LAA封堵手术依赖多种成像方式，包括经食管超声心动图（TEE）或3D-MDCT以及荧光透视。有效整合这些成像方式可能会提高植入安全性和成功率。据我们所知，此前尚未有针对LAA封堵的此项技术描述。
本观察性研究比较了采用或未采用融合整合进行手术的临床和手术参数。所有患者术前均进行3D-MDCT以测量LAA，并对LAA形态及周围结构进行3D分析。使用图像融合软件（英国通用电气医疗集团的Valve ASSIST 2）在荧光透视下识别标志点，然后在手术过程中将MDCT LAA解剖轮廓投影到实时荧光透视图像上，以指导干预的所有步骤。
共有57例患者接受了LAA封堵，其中16例使用了融合软件。与未融合组相比，造影剂用量减少（21.0±11.7 vs. 95.9±80.5 ml, P<0.001）、手术时间缩短（63.0±22.0 vs. 87.3±43.0分钟, P = 0.01）、荧光透视时间缩短（6.2 vs. 8.3分钟, P = 0.03）。封堵不完全（0 vs. 14.6%, P = 0.16）和器械植入成功率（100 vs. 92.7%, P = 0.17）无显著差异。
添加这种新型融合技术是安全可行的。为优化LAA手术成功率，融合整合可能为当前成像方式提供有前景的补充或替代方案。©2017威利期刊公司
