Use of short roll C-arm computed tomography and fully automated 3D analysis tools to guide transcatheter aortic valve replacement

• Published in: International Journal of Cardiovascular Imaging Vol. 32; no. 7; pp. 1145 - 1152
• Main Authors: Kim, Michael S., Bracken, John, Eshuis, Peter, Chen, S. Y. James, Fullerton, David, Cleveland, Joseph, Messenger, John C., Carroll, John D.
• Format: Journal Article
• Language: English
• Published: Dordrecht Springer Netherlands 01.07.2016; Springer Nature B.V
• Subjects: Aortic Valve - diagnostic imaging; Aortic Valve - physiopathology; Aortic Valve Stenosis - diagnostic imaging; Aortic Valve Stenosis - physiopathology; Aortic Valve Stenosis - therapy; Aortography - methods; Automation; Cardiac Catheterization - adverse effects; Cardiac Catheterization - instrumentation; Cardiac Catheterization - methods; Cardiac Imaging; Cardiology; Computed Tomography Angiography; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - instrumentation; Heart Valve Prosthesis Implantation - methods; Humans; Imaging; Imaging, Three-Dimensional; Medicine; Medicine & Public Health; Multidetector Computed Tomography; Original Paper; Predictive Value of Tests; Radiation Dosage; Radiation Exposure; Radiographic Image Interpretation, Computer-Assisted; Radiography, Interventional - methods; Radiology; Severity of Illness Index; Software; Treatment Outcome; X-ray aortography; C-arm computed tomography; Image guidance; Transcatheter aortic valve replacement; Coplanar view
• DOI: 10.1007/s10554-016-0886-0
• ISSN: 1569-5794

Determination of the coplanar view is a critical component of transcatheter aortic valve replacement (TAVR). The safety and accuracy of a novel reduced angular range C-arm computed tomography (CACT) approach coupled with a fully automated 3D analysis tool package to predict the coplanar view in TAVR was evaluated. Fifty-seven patients with severe symptomatic aortic stenosis deemed prohibitive-risk for surgery and who underwent TAVR were enrolled. Patients were randomized 2:1 to CACT vs. angiography (control) in estimating the coplanar view. These approaches to determine the coplanar view were compared quantitatively. Radiation doses needed to determine the coplanar view were recorded for both the CACT and control patients. Use of CACT offered good agreement with the actual angiographic view utilized during TAVR in 34 out of 41 cases in which a CACT scan was performed (83 %). For these 34 cases, the mean angular magnitude difference, taking into account both oblique and cranial/caudal angulation, was 1.3° ± 0.4°, while the maximum difference was 7.3°. There were no significant differences in the mean total radiation dose delivered to patients between the CACT and control groups as measured by either dose area product (207.8 ± 15.2 Gy cm 2 vs. 186.1 ± 25.3 Gy cm 2 , P = 0.47) or air kerma (1287.6 ± 117.7 mGy vs. 1098.9 ± 143.8 mGy, P = 0.32). Use of reduced-angular range CACT coupled with fully automated 3D analysis tools is a safe, practical, and feasible method by which to determine the optimal angiographic deployment view for guiding TAVR procedures.