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• W2046790033 abstract "Despite the lack of randomized trials comparing transapical aortic valve implantation (TA-AVI) with surgical aortic valve replacement, there is consensus that the approach may be advantageous for a high-risk group of patients.1Al-Attar N. Himbert D. Descoutures F. Iung B. Raffoul R. Messika-Zeitoun D. et al.Transcatheter aortic valve implantation: selection strategy is crucial for outcome.Ann Thorac Surg. 2009; 87: 1757-1763Abstract Full Text Full Text PDF PubMed Scopus (54) Google Scholar, 2Webb J.G. Altwegg L. Boone R.H. Cheung A. Ye J. Lichtenstein S. et al.Transcatheter aortic valve implantation: impact on clinical and valve-related outcomes.Circulation. 2009; 119: 3009-3016Crossref PubMed Scopus (514) Google Scholar Nevertheless, several complications are associated with TA-AVI. Paravalvular leak resulting in aortic insufficiency of grade II or more is reported at a high incidence3Clavel M.A. Webb J.G. Pibarot P. Altwegg L. Dumont E. Thompson C. et al.Comparison of the hemodynamic performance of percutaneous and surgical bioprostheses for the treatment of severe aortic stenosis.J Am Coll Cardiol. 2009; 53: 1983-1991Abstract Full Text Full Text PDF Scopus (290) Google Scholar and promotes left ventricular dysfunction, hemolysis, and endocarditis.4Walther T. Falk V. Hemodynamic evaluation of heart valve prostheses paradigm shift for transcatheter valves?.J Am Coll Cardiol. 2009; 53: 1992-1993Abstract Full Text Full Text PDF Scopus (24) Google Scholar The onset of atrioventricular block (AVB) is correlated with the implantation of large-diameter valves in patients with a small annulus diameter.5Bleiziffer S. Ruge H. Hörer J. Hutter A. Geisbüsch S. Brockmann G. et al.Predictors for new-onset complete heart block after transcatheter aortic valve implantation.JACC Cardiovasc Interv. 2010; 3: 524-530Abstract Full Text Full Text PDF PubMed Scopus (187) Google Scholar Although some of the reported complications are inherent to the procedure, others may be reduced by careful procedure planning. Three-dimensional template-based planning, as used in dental and orthopedic surgery, is proposed as an intuitive tool for this task. We present an initial retrospective patient trial of a system for 3-dimensional template-based TA-AVI planning. A total of 32 patients with TA-AVI (21 female, mean age 81 years) and severe aortic stenosis were selected for the study. All patients received an Edwards-Sapien implant (Edwards Lifesciences Inc, Irvine, Calif); implant sizing had been performed using computed tomography or 3-dimensional ultrasound images. Our study used preoperative data acquired from these patients for a retrograde implantation planning with a novel, 3-dimensional template-based planning system. We compared our planning results with the original implantation decisions to investigate the potential impact of such a tool on the onset of postoperative aortic insufficiency and AVB. The procedure was blinded in the sense that no information about the actual implanted valves or the operating room outcomes influenced the planning process. The institutional review board approved use of the patient data for this work, and informed consent was obtained from the patients. The generation and use of intraoperative DynaCT images (Syngo DynaCT; Siemens AG Healthcare Sector, Erlangen, Germany) to facilitate TA-AVI were recently described. These are 3-dimensional images reconstructed from contrast-enhanced angiography projections intraoperatively acquired with a ceiling-mounted rotation angiography system (Figure 1, A). The 3-dimensional planning system uses these images as a basis for implantation planning. A virtual model of the aortic root is extracted (Figure 1, B). To facilitate orientation and implant registration, anatomic landmarks can be identified to indicate the position of the coronary ostia, the commissures, and the hinge points (Figure 1, C). These landmarks help the operator in identifying a cut plane through the dataset that represents the annular level on which the Sapien implant is positioned. The system automatically registers 3-dimensional templates that represent the available valve models and sizes (Edwards-Sapien 23- and 26-mm valves and Ventor Embracer [Medtronic Ventor Technologies Ltd, Netanya, Israel]) with the dataset according to the landmarks and annulus plane (Figure 1, D). The operator can switch between different valves and adjust their virtual position. In the current study, the criterion for valve selection was the valve diameter, which was optimized to exceed the mean diameter of the aortic root at the level of the valvar hinges by 1 to 2 mm. One patient died of renal and pulmonary insufficiency. Another patient had left main stem occlusion during implantation related to inadequate positioning. AVB grade III was treated with pacemaker implantation in 4 patients. Temporary symptomatic bradycardia was diagnosed in 2 patients, but pacemaker implantation was not required. Notable aortic insufficiency was diagnosed in 11 cases. Figure 2 summarizes the variation between the implant selection based on 3-dimensional template-based planning and the original implant selection based on transesophageal echocardiography and computed tomography. In 17 cases, the planning decision was in accordance with the actually implanted valve size. Aortic insufficiency was seen in 3 of these cases, and 2 patients required pacemaker implantation. In 2 cases, template-based planning promoted a 23-mm valve in patients who had been treated with a 26-mm valve. Both cases required permanent pacemakers to treat grade III AVBs. In 2 cases with 23-mm valve implants, planning recommended the implantation of a 26-mm valve. One of these patients had paravalvular leakage with mild to moderate aortic insufficiency. In the other patient, no complications were reported. In 7 patients who were treated with the 26-mm implant, planning suggested that the 26-mm valve (which is the largest model available) was still too small for the patient. In all 7 patients, paravalvular leak grade I or greater was found. In 10 of 15 patients with postoperative AI or AVB, the new system would have promoted a different valve selection. These observations suggest that the template-based planning approach is a viable aid in preoperative assessment of the atrioventricular geometry and valve selection. To substantiate the reported findings, larger studies are necessary." @default.
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• W2046790033 date "2011-06-01" @default.
• W2046790033 modified "2023-10-16" @default.
• W2046790033 title "Three-dimensional template-based planning for transapical aortic valve implantation" @default.
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• W2046790033 doi "https://doi.org/10.1016/j.jtcvs.2010.09.041" @default.
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