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As a patient, when you hear “aortic stenosis” and “aortic valve implantation” your mind will race. Open Heart Surgery? How do I prepare? What if my surgery doesn’t go well? Luckily for patients everywhere, a doctor named Alain Cribier, a French Interventional Cardiologist and Professor of Medicine at the University of Rouen’s Charles Nicolle Hospital, developed a procedure called Transcatheter Aortic Valve Implantation (TAVR)1. His procedure is minimally invasive, being delivered by a catheter, and doesn’t require all the big equipment and long recovery times that open-heart surgery normally requires.
It wasn’t until late 2011 that the procedure was approved for use in the United States2. The American Heart Association describes the procedure well: “This minimally invasive surgical procedure repairs the valve without removing the old, damaged valve. Instead, it wedges a replacement valve into the aortic valve’s place… Once the new valve is expanded, it pushes the old valve leaflets out of the way and the tissue in the replacement valve takes over the job of regulating blood flow.3” Even though this procedure has been described as much easier on the patient and requires less equipment for the doctors, none of it would be possible without extensive planning and the advanced visualization tools required to meet the procedure’s demand.
Today, advanced processing engines identify vessels and draw lines down the center of them. These are appropriately named centerlines but, why are they important? Centerlines can be selected within software and “inflated” which means they can isolate only the vessels a radiologist needs to plan the procedure for the surgeon. As the centerline is inflated to encompass the vessel, the radiologist can make measurements and plan ahead for potential obstacles. Vessels aren’t always anatomically clean or easy to navigate like you see in text books; they bend and grow in different directions, sometimes expanding or tapering at different junctions. All this can be problematic for a surgeon who needs to lead a catheter through the femoral artery. If too many obstacles are in the way to make a transfemoral approach then a transapical approach must be taken instead. This requires even more extensive planning but has a more direct route to the aorta.
If centerlines are so important, then why do we leave it up to machines to make all those calculations? When was the last time you bought a device that worked 100% of the time? iPhones drop calls all the time and taking calls are their whole job! The short answer, for centerlines anyway, is that we don’t just leave it up to the machine. In fact, part of the guided workflow TeraRecon offers allows the user to double check the centerline and ensure that it is accurate. If it is not perfectly in the center, you have the option to adjust nodes on the line or even add new nodes to fine tune it. Beware of software systems that won’t let you make adjustments. This is critical to obtaining measurements of the vessel with high degrees of confidence, allowing replacement valves to fit and function properly.
TAVR is a groundbreaking procedure and it’s only getting better with new generations of implants. The procedure itself grants new opportunities to people who may have been ineligible for surgical treatments in the past and, in general, will lead to faster recovery times than invasive surgeries. If your health system is not yet providing TAVR procedures or if you plan to in the future, ensure you build your program on a system with unmatched performance. After recently being named the Ground Truth application for a centerline placement study in the Endovascular Journal of Medicine, TeraRecon takes pride in being the standard that other systems are vetted against. Check out the data on page 5 of the white paper. Why build a vascular program on anything less than the best?
Watch our new TAVR video to find out why TeraRecon's Intuition remains the industry's best-in-class vessel analysis solution with accurate measurements and speed.
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