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3D-echocardiography-angiography fusion technology for complex Mitral valve interventionen in the hybrid operating theater
Simon H. Sündermann, Jürg Grünenfelder, Michael Gessat, Patric Biaggi, Christian Felix, Dominique Bettex, Roberto Corti, Volkmar Falk.
University Hospital Zurich, Zurich, Switzerland.

OBJECTIVE: To evaluate the safety of EchoNavigator (Philips Healthcare, Best, Niederlande) during MitraClip (MC, Abbott Vascular Inc. Menlo Park, CA, USA) procedures.
METHODS: 21 patients were included. EchoNavigator automatically localizes the TEE probe in angiography images to combine real time TEE images with angiography images for adaption of the TEE images to the angulation of the C-arm. Septal puncture side and aimed position of the MC were marked in the TEE by the operator. All measured parameters were compared to the 21 patients treated directly before the installation of EchoNavigator. Endpoint of this study was safety of the us of EchoNavigator in MC porecuders and its effect at the length of the procedure, length of partial steps and the radiation time and dose.
RESULTS: EchoNavigator could be used without influencing the safety of the intervention. Mean length was 136.2±50.2 min (67.3±25.2 min/MC if more than one clip was implanted). Mean interval from groin puncture to placement of the first clip was 53.3±14 min, 83.2±27.4 min. to the second clip (17 patients), 134.2±23.2 min. to the third clip (5 patients) and 172.5±47.4 min. to the forth clip (2 patients). Mean angiography time was 32.3±16.8 min (11.1±7.2 min./MC). Mean radiation dose was 146.5±123.6 Gy/cm2 (47.8±38.5 Gy/cm2/MC). In the control group a tendency to a reduction of the length of intervention per MC, of partial steps (lengths/MC -8.3 min.(-12%), 1. MC -0.3 min. (-1%), 2. MC -5.5 min. (-7%), 3. MC -75 min.(-56%)) and the radiation dose per MC (-25.9 Gy/cm2, -53%) could be seen but without reaching statistical significance.
CONCLUSIONS: EchoNavigator is the first program, which enables fusion of TEE and angiography. Safe use was possible during MitraClip interventions. With the use of EchoNavigator image fusion is done automatically and has not to be performed mentally by the operator. Manipulation of catheters becomes easier and faster by trend. Further studies are necessary to confirm these results.


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