Phantom study of an ultrasound guidance system for transcatheter aortic valve implantation

A guidance system using transesophageal echocardiography and magnetic tracking is presented which avoids the use of nephrotoxic contrast agents and ionizing radiation required for traditional fluoroscopically guided procedures. The aortic valve is identified in tracked biplane transesophageal echocardiography and used to guide stent deployment in a mixed reality environment. Additionally, a transapical delivery tool with intracardiac echocardiography capable of monitoring stent deployment was created. This system resulted in a deployment depth error of 3.4mm in a phantom. This was further improved to 2.3mm with the custom-made delivery tool. In comparison, the variability in deployment depth for traditional fluoroscopic guidance was estimated at 3.4mm.

[1]  Elena Rizzo,et al.  A fully echo-guided trans-apical aortic valve implantation. , 2009, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[2]  Thierry Carrel,et al.  Risk of acute kidney injury in patients with severe aortic valve stenosis undergoing transcatheter valve replacement. , 2009, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[3]  G. Schuler,et al.  Dyna-CT during minimally invasive off-pump transapical aortic valve implantation. , 2009, The Annals of thoracic surgery.

[4]  Ming Li,et al.  Midterm results of transapical aortic valve replacement via real-time magnetic resonance imaging guidance. , 2010, The Journal of thoracic and cardiovascular surgery.

[5]  Terry M. Peters,et al.  Feature identification for image-guided transcatheter aortic valve implantation , 2012, Medical Imaging.

[6]  Navid Madershahian,et al.  Minimally invasive transapical aortic valve implantation and the risk of acute kidney injury. , 2010, The Annals of thoracic surgery.

[7]  Thomas Walther,et al.  Risk of acute kidney injury after minimally invasive transapical aortic valve implantation in 270 patients. , 2011, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[8]  Terry M Peters,et al.  The critical role of imaging navigation and guidance in transcatheter aortic valve implantation. , 2012, The Journal of thoracic and cardiovascular surgery.

[9]  Philippe Pibarot,et al.  Acute kidney injury following transcatheter aortic valve implantation: predictive factors, prognostic value, and comparison with surgical aortic valve replacement , 2009, European heart journal.

[10]  Terry M. Peters,et al.  A Navigation Platform for Guidance of Beating Heart Transapical Mitral Valve Repair , 2013, IEEE Transactions on Biomedical Engineering.

[11]  L. V. von Segesser,et al.  Transapical aortic valve implantation without angiography: proof of concept. , 2010, The Annals of thoracic surgery.

[12]  J. Chan,et al.  Impact of optimising fluoroscopic implant angles on paravalvular regurgitation in transcatheter aortic valve replacements - utility of three-dimensional rotational angiography. , 2012, EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology.

[13]  S. Pocock,et al.  Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. , 2010, The New England journal of medicine.

[14]  Lixu Gu,et al.  Intra-Operative 2-D Ultrasound and Dynamic 3-D Aortic Model Registration for Magnetic Navigation of Transcatheter Aortic Valve Implantation , 2013, IEEE Transactions on Medical Imaging.

[15]  Terry M. Peters,et al.  A Navigation Platform for Guidance of Beating Heart Transapical Mitral Valve Repair , 2013, IEEE Trans. Biomed. Eng..