title: Computer-Assisted Transcatheter Heart Valve Implantation in Valve-in-Valve Procedures.
abstract: OBJECTIVE
  Valve-in-valve (ViV) procedures are increasingly being considered as an alternative to redo surgery for the treatment of degenerated bioprosthetic heart valves in patients with excessive reoperative risk. The objective of our study was to evaluate the feasibility of computer guidance in transcatheter heart valve (THV) implantation during ViV procedures.
  
  
  METHODS
  Preprocedural electrocardiogram-gated computed tomography-scan images were processed using semiautomatic segmentation of the degenerated bioprosthesis' radiopaque landmarks and of the ascending aorta. Virtual three-dimensional (3D) reconstructions were created. A virtual plane was subsequently added to the 3D reconstructions, indicating the optimal landing plane of the THV inside the tissue valve. Within a hybrid operating theater, a 3D/2D registration was used to superimpose the 3D reconstructions, while dynamic tracking was allowed to maintain the superimposition onto the fluoroscopic images. The THV was afterward implanted according to the optimal landing plane. Projection of the ascending aorta and the coronary arteries was used to assess the risk of coronary ostia obstruction.
  
  
  RESULTS
  Between January 2014 and October 2014, nine patients underwent aortic ViV procedures in our institution. Among those nine patients, five procedures were retrospectively evaluated as a validation step using the proposed method. The mean (SD) superimposition error was 1.1 (0.75) mm. Subsequently, two live cases were prospectively carried out using our approach, successfully implanting the THV inside the degenerated tissue valve.
  
  
  CONCLUSIONS
  Our study demonstrates the feasibility of a computer-guided implantation of THV in ViV procedures. Moreover, it suggests that augmented reality may increase the reliability of THV implantation inside degenerated bioprostheses through better reproducibility.
authors.affiliation: From the *Department of Thoracic and Cardio-Vascular Surgery, Pontchaillou University Hospital, Rennes, France; †LTSI Laboratory, INSERM 1099U, Rennes 1 University, Rennes, France; and ‡Department of Cardiology, Pontchaillou University Hospital, Rennes, France.
authors.forename: Réda
authors.initials: R
authors.lastname: Belhaj Soulami
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Verhoye
authors.forename: Hung
authors.initials: H
authors.lastname: Nguyen Duc
authors.forename: Miguel
authors.initials: M
authors.lastname: Castro
authors.forename: Vincent
authors.initials: V
authors.lastname: Auffret
authors.forename: Amedeo
authors.initials: A
authors.lastname: Anselmi
authors.forename: Pascal
authors.initials: P
authors.lastname: Haigron
authors.forename: Vito Giovanni
authors.initials: VG
authors.lastname: Ruggieri
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001705:Bioprosthesis; D004562:Electrocardiography; D005240:Feasibility Studies; D005260:Female; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D015203:Reproducibility of Results; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted / Q000009:adverse effects / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D065467:Transcatheter Aortic Valve Replacement / Q000295:instrumentation* / Q000379:methods