Overtchouk Pavel, Sudre Arnaud, Delhaye Cédric, Juthier Francis, Van Belle Eric, Coisne Augustin, Koussa Mohamad, Mylotte Darren, Modine Thomas
Department of Cardiology and Cardiovascular Surgery, Institut Coeur Poumon, Centre Hospitalier Regional et Universitaire de Lille, Lille, France.
INSERM UMR 1011, Lille, France.
Interact Cardiovasc Thorac Surg. 2018 Oct 1;27(4):512-519. doi: 10.1093/icvts/ivy136.
Radiation exposure is a concern for both patients and operators during transcatheter aortic valve implantation (TAVI). Efforts to reduce radiation dose are warranted. We aimed at investigating if per-operative advanced image processing can reduce patient and operator irradiation use during TAVI.
We performed a prospective single-centre observational study comparing patient and operator radiation exposure using standard fluoroscopy (control group) or a novel technology of live advanced fluoroscopic image processing (test group) among consecutive patients undergoing TAVI between August 2015 and April 2016. Patient irradiation (dose-area product, effective dose and air kerma), contrast media volume and clinical outcomes were assessed.
Among 152 elderly [median age (interquartile range): 83 (78-87)] patients (n = 76 per group) undergoing TAVI, baseline clinical characteristics were similar between the control and test groups, except for a higher median EuroSCORE II (2.8% vs 2.3%, P = 0.02) and higher rate of TAVI for failing surgical bioprosthesis (11.8% vs 2.6%, P = 0.03) in the control group. The dose-area product was reduced in the test group: mean reduction of -27.5 Gy × cm2 [95% confidence intervals (CIs): 15.9-39.1, P < 0.001]. Furthermore, effective dose [mean reduction -6.5 (95% CI: 5.9-7.2) mSv, P < 0.001] and air kerma [mean reduction -167.5 (95% CI 163.4-177.3) mGy, P < 0.001] were lower in the test group. Fluoroscopy time, contrast volume and clinical outcomes were similar.
Patient radiation exposure was significantly reduced using a novel live advanced fluoroscopy image processing with calcification enhancement and fusion of the virtual aortic annulus without compromising patient safety.
在经导管主动脉瓣植入术（TAVI）过程中，辐射暴露是患者和操作人员都关心的问题。因此有必要努力降低辐射剂量。我们旨在研究术中先进的图像处理技术是否能减少TAVI过程中患者和操作人员所受的辐射。
我们进行了一项前瞻性单中心观察性研究，在2015年8月至2016年4月连续接受TAVI的患者中，比较使用标准荧光透视（对照组）或新型实时先进荧光透视图像处理技术（试验组）时患者和操作人员的辐射暴露情况。评估患者的辐射剂量（剂量面积乘积、有效剂量和空气比释动能）、造影剂用量和临床结局。
在152例接受TAVI的老年患者（中位年龄[四分位间距]：83岁[78 - 87岁]）中（每组n = 76例），对照组和试验组的基线临床特征相似，但对照组的中位欧洲心脏手术风险评估系统（EuroSCORE）II分值较高（2.8%对2.3%，P = 0.02），因外科生物瓣膜功能衰竭而行TAVI的比例较高（11.8%对2.6%，P = 0.。03）。试验组的剂量面积乘积降低：平均降低-27.5 Gy×cm2 [95%置信区间（CI）：15.9 - 39.1，P < 0.001]。此外，试验组的有效剂量[平均降低-6.5（95% CI：5.9 - 7.2）mSv，P < 0.001]和空气比释动能[平均降低-167.5（95% CI 163.4 - 177.3）mGy，P <
使用一种新型的实时先进荧光透视图像处理技术，增强钙化并融合虚拟主动脉瓣环，在不影响患者安全的情况下，患者的辐射暴露显著降低。
