title: Comparison of Manual and Automated Preprocedural Segmentation Tools to Predict the Annulus Plane Angulation and C-Arm Positioning for Transcatheter Aortic Valve Replacement.
abstract: BACKGROUND
  Preprocedural manual multi-slice-CT-segmentation tools (MSCT-ST) define the gold standard for planning transcatheter aortic valve replacement (TAVR). They are able to predict the perpendicular line of the aortic annulus (PPL) and to indicate the corresponding C-arm angulation (CAA). Fully automated planning-tools and their clinical relevance have not been systematically evaluated in a real world setting so far.
  
  
  RESULTS
  The study population consists of an all-comers cohort of 160 consecutive TAVR patients with a drop out of 35 patients for technical and anatomical reasons. 125 TAVR patients underwent preprocedural analysis by manual (M-MSCT) and fully automated MSCT-ST (A-MSCT). Method-comparison was performed for 105 patients (Cohort A). In Cohort A, CAA was defined for each patient, and accordance within 10° between M-MSCT and A-MSCT was considered adequate for concept-proof (95% in LAO/RAO; 94% in CRAN/CAUD). Intraprocedural CAA was defined by repetitive angiograms without utilizing the preprocedural measurements. In Cohort B, intraprocedural CAA was established with the use of A-MSCT (20 patients). Using preprocedural A-MSCT to indicate the corresponding CAA, the levels of contrast medium (ml) and radiation exposure (cine runs) were reduced in Cohort B compared to Cohort A significantly (23.3±10.3 vs. 35.3 ±21.1 ml, p = 0.02; 1.6±0.7 vs. 2.4±1.4 cine runs; p = 0.02) and trends towards more safety in valve-positioning could be demonstrated.
  
  
  CONCLUSIONS
  A-MSCT-analysis provides precise preprocedural information on CAA for optimal visualization of the aortic annulus compared to the M-MSCT gold standard. Intraprocedural application of this information during TAVR significantly reduces the levels of contrast and radiation exposure.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT01805739.
authors.affiliation: Department of Medicine, Division of Cardiology, Pulmonary Diseases, Vascular Medicine, University Hospital Düsseldorf, Düsseldorf, Germany.
authors.forename: Verena
authors.initials: V
authors.lastname: Veulemans
authors.affiliation: Department of Medicine, Division of Cardiology, Pulmonary Diseases, Vascular Medicine, University Hospital Düsseldorf, Düsseldorf, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Zeus
authors.affiliation: Department of Medicine, Division of Cardiology, Pulmonary Diseases, Vascular Medicine, University Hospital Düsseldorf, Düsseldorf, Germany.
authors.forename: Laura
authors.initials: L
authors.lastname: Kleinebrecht
authors.affiliation: Department of Medicine, Division of Cardiology, Pulmonary Diseases, Vascular Medicine, University Hospital Düsseldorf, Düsseldorf, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Balzer
authors.affiliation: Department of Medicine, Division of Cardiology, Pulmonary Diseases, Vascular Medicine, University Hospital Düsseldorf, Düsseldorf, Germany.
authors.forename: Katharina
authors.initials: K
authors.lastname: Hellhammer
authors.affiliation: Department of Medicine, Division of Cardiology, Pulmonary Diseases, Vascular Medicine, University Hospital Düsseldorf, Düsseldorf, Germany.
authors.forename: Amin
authors.initials: A
authors.lastname: Polzin
authors.affiliation: Department of Medicine, Division of Cardiology, Pulmonary Diseases, Vascular Medicine, University Hospital Düsseldorf, Düsseldorf, Germany.
authors.forename: Patrick
authors.initials: P
authors.lastname: Horn
authors.affiliation: Clinic for Cardiovascular Surgery, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Blehm
authors.affiliation: Clinic for Cardiovascular Surgery, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany.
authors.forename: Jan-Philipp
authors.initials: JP
authors.lastname: Minol
authors.affiliation: Institute of Radiology, University Hospital Düsseldorf, Düsseldorf, Germany.
authors.forename: Patric
authors.initials: P
authors.lastname: Kröpil
authors.affiliation: Department of Medicine, Division of Cardiology, Pulmonary Diseases, Vascular Medicine, University Hospital Düsseldorf, Düsseldorf, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Westenfeld
authors.affiliation: Department of Medicine, Division of Cardiology, Pulmonary Diseases, Vascular Medicine, University Hospital Düsseldorf, Düsseldorf, Germany.
authors.forename: Tienush
authors.initials: T
authors.lastname: Rassaf
authors.affiliation: Clinic for Cardiovascular Surgery, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany.
authors.forename: Artur
authors.initials: A
authors.lastname: Lichtenberg
authors.affiliation: Department of Medicine, Division of Cardiology, Pulmonary Diseases, Vascular Medicine, University Hospital Düsseldorf, Düsseldorf, Germany.
authors.forename: Malte
authors.initials: M
authors.lastname: Kelm
mesh_terms: D015331:Cohort Studies; D017023:Coronary Angiography / Q000379:methods*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D008297:Male; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*