Abstract 12019: Augmented Reality Guidance for Cerebral Embolic Protection (CEP) With the Sentinel Device During Transcatheter Aortic Valve Replacement (TAVR): First-In-Human Study

• Published in: Circulation (New York, N.Y.) Vol. 138; no. Suppl_1 Suppl 1; p. A12019
• Main Authors: Sadri, Shirin, Loeb, Gabrielle, Grinshpoon, Alon, Elvezio, Carmine, Velagapudi, Poonam, Ng, Vivian G, Khalique, Omar, Moses, Jeffrey W, Sommer, Robert J, Patel, Amisha J, George, Isaac, Hahn, Rebecca T, Leon, Martin B, Kirtane, Ajay J, Nazif, Tamim M, Kodali, Susheel K, Feiner, Steven K, Vahl, Torsten P
• Format: Journal Article
• Language: English
• Published: by the American College of Cardiology Foundation and the American Heart Association, Inc 06.11.2018
• ISSN: 0009-7322; 1524-4539

IntroductionAugmented reality (AR) can improve transcatheter interventions by providing 3D visualization of patient anatomy, with potential to reduce contrast and procedure time. We present a novel AR guidance system that displays virtual, patient-specific 3D anatomic models and assess intraprocedural impact during TAVR with CEP in six patients.HypothesisCurrently, placement of CEP filters in TAVR requires aortic arch angiograms to show arterial anatomy. AR guidance may facilitate enhanced catheter manipulation during CEP, enabling filter placement without intraprocedural arch angiograms.MethodsSix patients with prior CT imaging underwent TAVR with AR guidance prospectively from April to May 2018. Mean patient age was 90.3±5.3y and STS score 8.5±5.5%. For each patient, a 3D model of the aortic arch with carotid and subclavian arteries was segmented from CT with 3mensio software and deployed to Microsoft HoloLens, a stereoscopic optical see-through AR head-worn display. All patients had a Sentinel CEP device placed, which consists of two filters positioned in the brachiocephalic and left common carotid arteries. Physicians wore the HoloLens and manipulated virtual 3D models and live fluoroscopy intraprocedurally while remaining sterile using voice, hand gestures, and head motion with our newly developed AR user interface, as seen in Figure 1. The primary goal was to assess safety and feasibility of CEP with AR guidance.ResultsCEP was placed safely and successfully in all six patients. AR guidance eliminated the need for aortic arch angiograms and additional contrast prior to CEP filter placement, as confirmed with fluoroscopy and post-procedure physician interviews. Mean times to first and second filter placement were 58±58 s and 141±63 s respectively.ConclusionsAR guidance enables physicians to perform CEP during TAVR safely and without contrast, demonstrating potential to make transcatheter interventions faster, safer, and more effective.