Kerner Arthur, Abadi Sobhi, Dotan Roy, Javitt Marcia, Aronson Doron, Lessick Jonathan
Cardiology Department, Rambam Health Care Campus, Haifa, Israel.
Technion-Israel Institute of Technology, Haifa, Israel.
J Heart Valve Dis. 2017 Mar;26(2):130-138.
A comparison was made between the accuracy of and time saved by using novel automated software for pre-procedural computed tomography (CT) planning before transcatheter aortic valve implantation (TAVI) and manual methods. Preprocedural CT to assess aortic annulus dimensions and predict the optimal C-arm implant angle before TAVI can reduce complications related to incorrect prosthesis sizing and positioning.
A total of 61 consecutive patients underwent TAVI using either the SAPIEN XT or CoreValve prosthesis. Pre-procedural CT scans were analysed using three methods: automatic; semi-automatic; and manual. For each method, annular dimensions were measured and the optimal implantation angle was predicted. After TAVI the actual post-deployment angle orthogonal to the prosthesis was determined using aortic fluoroscopy. The difference between the predicted angle by CT and the measured post-deployment angle was calculated for each method.
For all methods the mean angular difference with the actual post-deployment angle was similar at ~9 ± 7°. There was a significant difference between the SAPIEN XT (6.6 ± 5.8°) and CoreValve (11.5 ± 6.9°, p <0.001) prostheses due to a consistently greater left anterior oblique and caudal angulation for the CoreValve. Although the annular area correlated well among all methods, 'automatic' results were consistently larger than 'manual' results. Interobserver variability was low for all measures. The fully automatic method saved 98 s, and the semiautomatic method 40 s per case.
The use of automatic software enabled a rapid and accurate prediction of implantation angles, though results differed for specific manufacturers. Annular areas were overestimated by the automatic method, and thus required manual adjustments.
对经导管主动脉瓣植入术（TAVI）前使用新型自动化软件进行术前计算机断层扫描（CT）规划的准确性和节省的时间与手动方法进行了比较。术前CT评估主动脉瓣环尺寸并预测TAVI前最佳C形臂植入角度可减少与假体尺寸和定位不正确相关的并发症。
共有61例连续患者接受了使用SAPIEN XT或CoreValve假体的TAVI。术前CT扫描采用三种方法进行分析：自动；半自动；和手动。对于每种方法，测量瓣环尺寸并预测最佳植入角度。TAVI后，使用主动脉荧光透视确定与假体正交的实际部署后角度。计算每种方法的CT预测角度与测量的部署后角度之间的差异。
对于所有方法，与实际部署后角度的平均角度差异相似，约为9±7°。由于CoreValve的左前斜和尾侧角度始终较大，SAPIEN XT（6.6±5.8°）和CoreValve（11.5±6.9°，p<0.001）假体之间存在显著差异。尽管所有方法之间的瓣环面积相关性良好，但“自动”结果始终大于“手动”结果。所有测量的观察者间变异性都很低。全自动方法每例节省98秒，半自动方法每例节省40秒。
使用自动软件能够快速准确地预测植入角度，但不同特定制造商的结果有所不同。自动方法高估了瓣环面积，因此需要手动调整。
