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Aortic root assessment using perioperative DynaCT imaging during transcatheter aortic valve implantation
Arnaud Van Linden, Jörg Kempfert, Johannes Blumenstein, Helge Möllmann, Won-Keun Kim, Serap Alkaya, Tibor Ziegelhöffer, Thomas Walther.
Kerckhoff Klinik, Bad Nauheim, Germany.
OBJECTIVE: Precise imaging is paramount during transcatheter aortic valve implantation (TAVI). Intraoperative rotational angiography followed by automatic segmentation and 3-dimensional reconstruction of the aortic root (DynaCT) is a new perioperataive imaging tool during TAVI. Aim of this study was to compare perioperative DynaCT to the current golden-standard of conventional multislice computed tomography (MSCT).
METHODS: Raw image dataset of preoperative MSCT and intraoperative DynaCT was acquired in 40 patients undergoing TAVI. A software prototype (SIEMENS syngo/Aortic ValveGuide™) which allows for automatic segmentation of the aortic root anatomy with potential for manual correction was used to measure the distances from the aortic annulus to the coronary ostia (Image). DynaCT images were acquired during a short period of rapid ventricular pacing with injection of diluted contrast (total contrast use 15cc/patient).
RESULTS: Mean difference between the distance of the left main stem and the aortic annulus automatically detected in DynaCT (LMaut) vs. the distance in standard MSCT (LMstand) was 0.4±2.7 mm (p=0.371). Mean difference between LM manually corrected in DynaCT (LMcorr) vs. LMstand was 0.8±2.7 mm (p=0.059). Bland-Altman analysis for comparing manually corrected LM in DynaCT vs. manually corrected LM in MSCT showed a mean difference of -0.3 mm (range -2.6 - 4.1 mm) with a limit of agreement of -3.2 - 2.6 mm.
CONCLUSIONS: Perioperative DynaCT is a useful tool to precisely measure the distances between the coronary ostia and the aortic annulus. No significant difference was found comparing the distances measured at DynaCT versus the golden-standard MSCT for the left main stem. The raw dataset acquired by DynaCT showed good agreement to the MSCT dataset in Bland-Altman analysis, which supports the findings of good correlation between the two imaging techniques. Perioperative DynaCT may evolve to the perfect perioperative imaging technique that provides all information that is mandatory for TAVI procedures. 
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