Fig 1.
The study population consists of an all-comers cohort of 160 consecutive TAVR patients and 35 patients have been excluded. Cohort A: CT-datasets in this cohort were analyzed to perform method-comparison (see text, n = 105). Automated MSCT analysis software (A-MSCT) and manual software (M-MSCT) were used to determine the perpendicular valve plane angulation (PPL). Cohort B: Here, intraprocedural C-arm angulation (CAA) was established with the use of A-MSCT.
Fig 2.
Preprocedural Alignment of the Aortic Root Planes.
Colored lines through selected CT images reflect the 3D schematic reconstructions in several planes using a manual software (M-MSCT) (A, coronal, sagittal and axial planes). The axial plane presents the basis for the alignment of the hinge point plane, in which no valve structure is visible (hinge points). Three points were set on the axial plane, and the 3D volume-rendered reconstruction was initiated. The angles were determined by manually rotating the 3D aortic reconstructions to reach the appropriate projection with a perpendicular view. The automated software (A-MSCT) automatically places fiducial marks at the hinge points (yellow points), representing the aortic valve plane (B). The aortic root angiogram displays a perpendicular valve view on the aortic valve annulus (C). NCC = noncoronary cusp; RCC = right coronary cusp; LCC = left coronary cusp; LAO = left anterior oblique; CAUD = caudal; CRAN = cran; M-MSCT = Manual derived CAA by MSCT; A-MSCT = Automated derived CAA by MSCT; CAA = Intraprocedural C-arm angulation.
Fig 3.
Relationship of the MSCT-derived Prediction of the Perpendicular View Angulation between Automated (A-MSCT) and Manual (M-MSCT) Software (Cohort A, method-comparison).
Bland–Altman plots and linear regression analyses comparing M-MSCT and A-MSCT in the LAO/RAO and CRAN/CAUD directions.
Table 1.
Comparison of the Mean Perpendicular Valve Angulations.
Table 2.
Comparison of the Mean Deviation of the Perpendicular Valve Angulations and Correspondance in Cohort A.
Table 3.
Patient Procedural Characteristics and Outcomes.
Fig 4.
Clinical Outcome by Using the Preprocedural MSCT-datasets during Valve-Positioning.
Preprocedural Use and Prediction of CAA is associated with a decrease in the amount of contrast agent use (A) and number of cine runs (B) until TAVR was reached.