Virtual Implantation Using 3d Ct Image Fusion For Preoperative Sizing Of Sutureless Aortic Valves
Priya R. Kothapalli, Moritz C. Wyler von Ballmoos, Ponraj Chinnadurai, Kavya Sinha, Alan B. Lumsden, Mahesh K. Ramchandani.
Houston Methodist Hospital, Houston, TX, USA.
Objective To evaluate the feasibility of virtual implantation of sutureless aortic valves using 3D CT image fusion to guide preoperative sizing. Methods Patients undergoing isolated aortic valve replacement with a sutureless valve (Perceval, LivaNova Inc.) had a preoperative cardiac CT angiography performed. Preoperative images were used to perform virtual implantation using the annular plane as a guide for appropriate seating of the aortic valve prosthetic. All four sizes of the sutureless valve were implanted virtually for comparison. The annular diameter was also measured using conventional methods. A cardiac surgeon blinded to the procedural details then determined the adequate valve size based on visual assessment of virtual implant images and annular diameter. This choice of prosthesis size was correlated with actual procedural implant data. Results Figure 1 demonstrates the technique of virtual implantation using scanned files of the Perceval valve with patient CT volumetric rendering data. Based on visual assessment and knowledge of the patient’s annular diameter, a size medium Perceval valve was selected as the appropriate size, corresponding to the actual implanted valve size. A post-operative CT scan shows an appropriately seated Perceval valve that correlates visually with virtual implant images obtained. 
Conclusions This study demonstrates the use of advanced fusion imaging as an adjunct to conventional sizing methods to guide selection of sutureless aortic valves. Given the match between pre- and post-images, our findings suggest that the process of virtual implantation may eventually be automated to register and align data. Additional data is required to develop these algorithms and is an active area of research.
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