Herzzentrum Brandenburg in Bernau bei Berlin & Medizinische Hochschule Brandenburg Theodor Fontane, Bernau, Germany.
Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan.
Catheter Cardiovasc Interv. 2019 Mar 1;93(4):722-728. doi: 10.1002/ccd.27920. Epub 2018 Nov 8.
Novel automated computed tomography (CT) software (Valve ASSIST 2) has been developed for transcatheter aortic valve implantation (TAVI), which not only provides three-dimensional (3D) reconstruction of multidetector (MD) CT images, but also enables intraprocedural real-time fusion of fluoroscopic and MDCT images. We aimed to clarify the reproducibility and accuracy of this software in the aortic annulus assessment and verify the potential of intraprocedural integrated MDCT imaging for TAVI.
We examined 50 patients with severe aortic stenosis undergoing transfemoral TAVI. Aortic annulus measurements were performed using 3mensio and the novel planning software. For intraprocedural imaging, preoperative CT dataset was overlaid onto fluoroscopy with the fusion software. The two images were aligned using the aortic root anatomy visible on both modalities. Novel planning software provided excellent reproducibility for the measurement of aortic annulus area (intraobserver intraclass correlation coefficients [ICC] 0.959, interobserver ICC 0.941), and perimeter (intraobserver ICC 0.915, interobserver ICC 0.912). Excellent correlation was found between novel planning software and 3mensio (ICC 0.952 for aortic annulus area, and 0.923 for perimeter). Intraprocedural fusion image of CT aortography and fluoroscopic aortic root aortography generated by this novel software identified coronary orifices and the distribution of aortic valve calcification during the device positioning. Fusion image displayed coronary orifices after device implantation.
Novel planning software showed excellent reproducibility and accuracy in the assessment of aortic root anatomy. Furthermore, the integrated 3D fusion image might have a potential as an intraprocedural imaging modality to contribute to the development of a safer TAVI procedure.
新型自动计算机断层扫描（CT）软件（Valve ASSIST 2）已被开发用于经导管主动脉瓣植入术（TAVI），它不仅提供了多排 CT 图像的三维（3D）重建，还实现了术中实时透视和 MDCT 图像的融合。我们旨在阐明该软件在主动脉瓣环评估中的可重复性和准确性，并验证术中整合 MDCT 成像在 TAVI 中的潜在应用。
我们检查了 50 名接受经股动脉 TAVI 的严重主动脉瓣狭窄患者。使用 3mensio 和新型规划软件进行主动脉瓣环测量。对于术中成像，使用融合软件将术前 CT 数据集叠加到透视图像上。使用两种模式下可见的主动脉根部解剖结构对两幅图像进行对齐。新型规划软件在主动脉瓣环面积（观察者内组内相关系数 [ICC] 0.959，观察者间 ICC 0.941）和周长（观察者内 ICC 0.915，观察者间 ICC 0.912）的测量中提供了出色的可重复性。新型规划软件与 3mensio 之间存在极好的相关性（主动脉瓣环面积的 ICC 为 0.952，周长的 ICC 为 0.923）。该新型软件生成的 CT 主动脉造影术中融合图像和透视主动脉根部造影术中融合图像可在器械定位过程中识别冠状动脉开口和主动脉瓣钙化的分布。融合图像显示器械植入后冠状动脉开口。
新型规划软件在评估主动脉根部解剖结构方面具有出色的可重复性和准确性。此外，集成的 3D 融合图像可能具有作为术中成像方式的潜力，有助于开发更安全的 TAVI 手术。
