title: Simulated Prosthesis Overlay for Patient-Specific Planning of Transcatheter Aortic Valve Implantation Procedures.
abstract: OBJECTIVE
  We tested the hypothesis that simulated three-dimensional prosthesis overlay procedure planning may support valve selection in transcatheter aortic valve implantation (TAVI) procedures.
  
  
  METHODS
  Preoperative multidimensional computed tomography (MDCT) data sets from 81 consecutive TAVI patients were included in the study. A planning tool was developed, which semiautomatically creates a three-dimensional model of the aortic root from these data. Three-dimensional templates of the commonly used TAVI implants are spatially registered with the patient data and presented as graphic overlay. Fourteen physicians used the tool to perform retrospective planning of TAVI procedures. Results of prosthesis sizing were compared with the prosthesis size used in the actually performed procedure, and the patients were accordingly divided into three groups: those with equal size (concordance with retrospective planning), oversizing (retrospective planning of a smaller prosthesis), and undersizing (retrospective planning of a larger prosthesis).
  
  
  RESULTS
  In the oversizing group, 85% of the patients had new pacemaker implantation. In the undersizing group, in 66%, at least mild paravalvular leakage was observed (greater than grade 1 in one third of the cases). In 46% of the patients in the equal-size group, neither of these complications was observed.
  
  
  CONCLUSIONS
  Three-dimensional prosthesis overlay in MDCT-derived patient data for patient-specific planning of TAVI procedures is feasible. It may improve valve selection compared with two-dimensional MDCT planning and thus yield better outcomes.
authors.affiliation: From the *Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany; †Computer Vision Laboratory, Swiss Federal Institute of Technology (ETH) Zurich, Zurich, Switzerland; ‡Division of Cardiology, University Hospital Zurich, Zurich, Switzerland; §Institute for Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland; and ∥Division of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Simon H
authors.initials: SH
authors.lastname: Sündermann
authors.forename: Michael
authors.initials: M
authors.lastname: Gessat
authors.forename: Willibald
authors.initials: W
authors.lastname: Maier
authors.forename: Jörg
authors.initials: J
authors.lastname: Kempfert
authors.forename: Thomas
authors.initials: T
authors.lastname: Frauenfelder
authors.forename: Thi D L
authors.initials: TD
authors.lastname: Nguyen
authors.forename: Francesco
authors.initials: F
authors.lastname: Maisano
authors.forename: Volkmar
authors.initials: V
authors.lastname: Falk
mesh_terms: D000369:Aged, 80 and over; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D011300:Preoperative Care / Q000379:methods*; D014057:Tomography, X-Ray Computed; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*