Clin Res Cardiol (2021) DOI DOI https://doi.org/10.1007/s00392-021-01843-w

Improved navigation during Cardioband transcatheter tricuspid annuloplasty

D. Bertsche1, M. Keßler1, D. Buckert1, L. Schneider1, W. Rottbauer1, V. Rasche1, S. Markovic1, I. Vernikouskaya1

1Klinik für Innere Medizin II, Universitätsklinikum Ulm, Ulm;

Background: Transcatheter annuloplasty procedures with the cardioband tricuspid valve reconstruction system (Cardioband, Edwards Lifesciences, Irvine, California) is a promising treatment for inoperable patients with tricuspid regurgitation. Implantation is currently guided by XR fluoroscopy and TEE. The identification of the pre-procedurally planned anchor location often remains challenging and time-consuming. Objective: To support navigation to the anticipated anchor implantation sites, pre-procedural planning data can be fused with live XR fluoroscopy. Method: Pre-procedural CT data were used for patient-specific planning. Using a planning software (3mensio version10.1, Pie Medical Imaging BV, Maastricht, The Netherlands), anchor positions and orientations, Cardioband size, and optimal peri-procedural XR fluoroscopic projection planes were determined. Anatomical landmarks comprising right coronary artery (RCA), valve annulus, coronary sinus ostium, and the aortic root circle were identified during planning. Based on the anatomical landmarks, all anchor positions and orientations, and the line connecting the anchor heads (trajectory) indicating a safe distance to RCA and hinge point were determined and marked in the CT volume data. From the marked CT, three-dimensional models of the anatomical landmarks, anchors, and trajectory were generated (EP navigator Release 5.1.1.4, Philips Healthcare, Best, The Netherlands). During the procedure, the volumetric data were co-registered to the XR fluoroscopy and superimposed using EP navigator software to facilitate easier identification of the pre-procedural planned anchor locations. The potential of the investigated techniques was assessed by self-disclosure of interventionalists. Results: Fusion of pre-procedural planned details with XR fluoroscopy is feasible during Cardioband procedures with tools already approved for clinical routine. The combined overlay of planning details and anatomical landmarks greatly facilitates the perception of the patient’s specific anatomy (Fig. 1). Further the potential of the overlay for guiding the identification of the first anchor position was highlighted. The planned anchor orientation could be adopted by alignment of the orientation of the catheter. The trajectory was pointed out as a useful overlay especially in case the pre-procedural planned anchor positions cannot be used. Conclusion: Augmentation of the XR fluoroscopy by the planning details may further facilitate the correct positioning of the catheter during anchor implantation. Even though final control of the anchor location and orientation by means of TEE remains important, the augmentation has the potential to efficiently guide the catheter into the target area of each anchor. Acknowledgements: The authors would like to thank Mr. Corc Savas (Edwards Lifesciences). The project on which this report is based was funded by the Federal Ministry of Education and Research under the funding code 13GW0372C. Responsibility for the content of this publication lies with the authors. Fig. 1: The fusion of live XR fluoroscopy and planning data, generated from a pre-procedural CT facilitates the perception of the patient’s specific anatomy.

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