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Updated: Mar 19, 2026
Improved Registration of 3D CT Angiography with X-ray Fluoroscopy for Image Fusion During Transcatheter Aortic Valve Implantation
Published on: June 3, 2018
Computer-Assisted Transcatheter Heart Valve Implantation in Valve-in-Valve Procedures
Réda Belhaj Soulami1, Jean-Philippe Verhoye, Hung Nguyen Duc
1From the *Department of Thoracic and Cardio-Vascular Surgery, Pontchaillou University Hospital, Rennes, France; †LTSI Laboratory, INSERM 1099U, Rennes 1 University, Rennes, France; and ‡Department of Cardiology, Pontchaillou University Hospital, Rennes, France.
Computer guidance for transcatheter heart valve (THV) implantation in valve-in-valve (ViV) procedures is feasible. This approach may improve the reliability and reproducibility of THV placement in degenerated bioprosthetic heart valves.
Area of Science:
- Cardiovascular Surgery
- Medical Imaging
- Biomedical Engineering
Background:
- Valve-in-valve (ViV) procedures offer an alternative to redo surgery for degenerated bioprosthetic heart valves in high-risk patients.
- Transcatheter heart valve (THV) implantation in ViV procedures requires precise placement to ensure optimal outcomes and avoid complications.
Purpose of the Study:
- To evaluate the feasibility of computer-guided THV implantation during ViV procedures.
- To assess the accuracy and reliability of a novel computer guidance system for THV placement.
Main Methods:
- Preprocedural CT scans were used for semi-automatic segmentation and 3D reconstruction of the bioprosthesis and aorta.
- A virtual optimal landing plane was determined and superimposed onto intraprocedural fluoroscopic images using 3D/2D registration and dynamic tracking.
- Risk of coronary ostia obstruction was assessed by projecting the aorta and coronary arteries.
Main Results:
- Five retrospective ViV procedures were evaluated with a mean superimposition error of 1.1 mm.
- Two prospective live cases successfully demonstrated THV implantation within the degenerated bioprosthesis using the computer-guided approach.
- The method showed high accuracy in guiding THV placement.
Conclusions:
- Computer guidance is feasible for THV implantation in ViV procedures.
- Augmented reality guidance may enhance the reliability and reproducibility of THV implantation in degenerated bioprostheses.
