title: CT angiography-fluoroscopy fusion imaging for percutaneous transapical access.
abstract: OBJECTIVE
  The aim of this proof-of-principle study is to validate the accuracy of fusion imaging for percutaneous transapical access (TA).
  
  
  BACKGROUND
  Structural heart disease interventions, including TA, are commonly obtained under fluoroscopic guidance, which lacks important spatial information. Computed tomographic angiography (CTA)-fluoroscopy fusion imaging can provide the 3-dimensional information necessary for improved accuracy in planning and guidance of these interventions.
  
  
  METHODS
  Twenty consecutive patients scheduled for percutaneous left ventricular puncture and device closure using CTA-fluoroscopy fusion guidance were prospectively recruited. The HeartNavigator software (Philips Healthcare, Best, the Netherlands) was used to landmark the left ventricular epicardium for TA (planned puncture site [PPS]). The PPS landmark was compared with the position of the TA closure device on post-procedure CTA (actual puncture site). The distance between the PPS and actual puncture site was calculated from 2 fixed reference points (left main ostium and mitral prosthesis center) in 3 planes (x, y, and z). The distance from the left anterior descending artery at the same z-plane was also assessed. TA-related complications associated with fusion imaging were recorded.
  
  
  RESULTS
  The median (interquartile range [IQR]) TA distance difference between the PPS and actual puncture site from the referenced left main ostium and mitral prosthesis center was 5.00 mm (IQR: 1.98 to 12.64 mm) and 3.27 mm (IQR: 1.88 to 11.24 mm) in the x-plane, 4.48 mm (IQR: 1.98 to 13.08 mm) and 4.00 mm (IQR: 1.62 to 11.86 mm) in the y-plane, and 5.57 mm (IQR: 3.89 to 13.62 mm) and 4.96 mm (IQR: 1.92 to 11.76 mm) in the z-plane. The mean TA distance to the left anterior descending artery was 15.5 ± 7.8 mm and 22.7 ± 13.7 mm in the x- and y-planes. No TA-related complications were identified, including evidence of coronary artery laceration.
  
  
  CONCLUSIONS
  With the use of CTA-fluoroscopy fusion imaging to guide TA, the actual puncture site can be approximated near the PPS. Moreover, fusion imaging can help maintain an adequate access distance from the left anterior descending artery, thereby, potentially reducing TA-related complications.
authors.affiliation: Department of Cardiovascular Medicine, Division of Structural and Congenital Heart Disease, Lenox Hill Heart and Vascular Institute-North Shore/Long Island Jewish Health System, New York, New York.
authors.forename: Chad
authors.initials: C
authors.lastname: Kliger
authors.affiliation: Department of Cardiovascular Medicine, Division of Structural and Congenital Heart Disease, Lenox Hill Heart and Vascular Institute-North Shore/Long Island Jewish Health System, New York, New York.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Jelnin
authors.affiliation: Department of Cardiovascular Medicine, Division of Structural and Congenital Heart Disease, Lenox Hill Heart and Vascular Institute-North Shore/Long Island Jewish Health System, New York, New York.
authors.forename: Sonnit
authors.initials: S
authors.lastname: Sharma
authors.affiliation: Department of Cardiovascular Medicine, Division of Structural and Congenital Heart Disease, Lenox Hill Heart and Vascular Institute-North Shore/Long Island Jewish Health System, New York, New York.
authors.forename: Georgia
authors.initials: G
authors.lastname: Panagopoulos
authors.affiliation: Department of Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Bryce N
authors.initials: BN
authors.lastname: Einhorn
authors.affiliation: Department of Cardiovascular Medicine, Division of Structural and Congenital Heart Disease, Lenox Hill Heart and Vascular Institute-North Shore/Long Island Jewish Health System, New York, New York.
authors.forename: Robert
authors.initials: R
authors.lastname: Kumar
authors.affiliation: Department of Cardiovascular Medicine, Division of Structural and Congenital Heart Disease, Lenox Hill Heart and Vascular Institute-North Shore/Long Island Jewish Health System, New York, New York.
authors.forename: Francisco
authors.initials: F
authors.lastname: Cuesta
authors.affiliation: Department of Cardiovascular Medicine, Division of Structural and Congenital Heart Disease, Lenox Hill Heart and Vascular Institute-North Shore/Long Island Jewish Health System, New York, New York.
authors.forename: Leandro
authors.initials: L
authors.lastname: Maranan
authors.affiliation: Department of Cardiovascular Medicine, Division of Structural and Congenital Heart Disease, Lenox Hill Heart and Vascular Institute-North Shore/Long Island Jewish Health System, New York, New York.
authors.forename: Itzhak
authors.initials: I
authors.lastname: Kronzon
authors.affiliation: Clinical Science Division, Philips Healthcare, Best, the Netherlands.
authors.forename: Bart
authors.initials: B
authors.lastname: Carelsen
authors.affiliation: Department of Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Howard
authors.initials: H
authors.lastname: Cohen
authors.affiliation: Department of Cardiovascular Medicine, Division of Structural and Congenital Heart Disease, Lenox Hill Heart and Vascular Institute-North Shore/Long Island Jewish Health System, New York, New York.
authors.forename: Gila
authors.initials: G
authors.lastname: Perk
authors.affiliation: Clinical Science Division, Philips Healthcare, Best, the Netherlands.
authors.forename: Rob
authors.initials: R
authors.lastname: Van Den Boomen
authors.affiliation: Clinical Science Division, Philips Healthcare, Best, the Netherlands.
authors.forename: Cherif
authors.initials: C
authors.lastname: Sahyoun
authors.affiliation: Department of Cardiovascular Medicine, Division of Structural and Congenital Heart Disease, Lenox Hill Heart and Vascular Institute-North Shore/Long Island Jewish Health System, New York, New York. Electronic address: cruiz@nshs.edu.
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Ruiz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D059925:Anatomic Landmarks; D006328:Cardiac Catheterization / Q000379:methods*; D017023:Coronary Angiography / Q000379:methods*; D005260:Female; D005471:Fluoroscopy; D006331:Heart Diseases / Q000000981:diagnostic imaging / Q000628:therapy*; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D064847:Multimodal Imaging / Q000379:methods*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011677:Punctures; D011857:Radiographic Image Interpretation, Computer-Assisted; D015641:Radiography, Interventional / Q000379:methods*; D015203:Reproducibility of Results
keywords: computed tomographic angiography–fluoroscopy fusion; fusion imaging; percutaneous transapical access; structural heart disease interventions