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

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Abstract

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 cm2 vs. 186.1 ± 25.3 Gy cm2, 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.

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Acknowledgments

This work was supported with funding from Philips Healthcare.

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Authors and Affiliations

  1. University of Colorado Denver, Anschutz Medical Campus, 12401 East 17th Avenue, B-132, Aurora, CO, 80045, USA

    Michael S. Kim, S. Y. James Chen, David Fullerton, Joseph Cleveland, John C. Messenger & John D. Carroll

  2. Philips Healthcare, Markham, ON, Canada

    John Bracken

  3. Philips Healthcare, Best, The Netherlands

    Peter Eshuis

Authors
  1. Michael S. Kim
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  2. John Bracken
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  3. Peter Eshuis
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  4. S. Y. James Chen
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  5. David Fullerton
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  6. Joseph Cleveland
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  7. John C. Messenger
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  8. John D. Carroll
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Corresponding author

Correspondence to Michael S. Kim.

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Conflict of interest

John Carroll, MD is a consultant, receives research support, and through the University of Colorado receives royalties (for intellectual property not related to this manuscript) from Philips Healthcare. Michael Kim, MD receives research support from Philips Healthcare. John Bracken, PhD and Peter Eshuis, PhD are employees of Philips Healthcare.

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Kim, M.S., Bracken, J., Eshuis, P. et al. Use of short roll C-arm computed tomography and fully automated 3D analysis tools to guide transcatheter aortic valve replacement. Int J Cardiovasc Imaging 32, 1145–1152 (2016). https://doi.org/10.1007/s10554-016-0886-0

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  • DOI: https://doi.org/10.1007/s10554-016-0886-0

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