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Practical Fluoroscopy Projection Algorithm for Transcatheter Aortic Valve Implantation to Improve Procedural Efficiency

      Fluoroscopy is the intraoperative imaging modality of choice to facilitate the optimal alignment of the transcatheter heart valve and aortic annulus during transcatheter aortic valve implantation (TAVI).
      • Salemi A
      • Worku BM.
      Standard imaging techniques in transcatheter aortic valve replacement.
      Preprocedural computed tomography can predict the orthogonal projection angles of the fluoroscopy C-arm with varying accuracy, previously reported at 40% to 50%.
      • Steinvil A
      • Weissman G
      • Ertel AW
      • Weigold G
      • Rogers T
      • Koifman E
      • Buchanan KD
      • Shults C
      • Torguson R
      • Okubagzi PG
      • Satler LF
      • Ben-Dor I
      • Waksman R.
      Accuracy of predicted orthogonal projection angles for valve deployment during transcatheter aortic valve replacement.
      In practice, the most common approach is to perform repeated “trial-and-error” aortograms until the implantation fluoroscopic view is observed. The “follow the right cusp” rule provides a guiding principle on fluoroscopy methods for TAVI
      • Kasel AM
      • Cassese S
      • Leber AW
      • von Scheidt W
      • Kastrati A
      Fluoroscopy-guided aortic root imaging for TAVR: “follow the right cusp” rule.
      ; however, this oversimplified algorithm does not consider the anatomic three-dimensional structure and inherited angulation of the aortic root and can often lead to repeated angiograms during TAVI.
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      References

        • Salemi A
        • Worku BM.
        Standard imaging techniques in transcatheter aortic valve replacement.
        J Thorac Dis. 2017; 9: S289-S298
        • Steinvil A
        • Weissman G
        • Ertel AW
        • Weigold G
        • Rogers T
        • Koifman E
        • Buchanan KD
        • Shults C
        • Torguson R
        • Okubagzi PG
        • Satler LF
        • Ben-Dor I
        • Waksman R.
        Accuracy of predicted orthogonal projection angles for valve deployment during transcatheter aortic valve replacement.
        J Cardiovasc Comput Tomogr. 2018; 12: 398-403
        • Kasel AM
        • Cassese S
        • Leber AW
        • von Scheidt W
        • Kastrati A
        Fluoroscopy-guided aortic root imaging for TAVR: “follow the right cusp” rule.
        JACC Cardiovasc Imaging. 2013; 6: 274-275