Dallas, USA - Minimally invasive treatment of structural heart diseases such as Transcatheter Aortic Valve Implantation (TAVI) procedures is becoming more popular as an alternative to surgery for very high-risk patients. These procedures, however, are challenging and complicated and experience is required to perform them skilfully.
The new device has just received FDA clearance in the United States and the first commercial installation in the USA has taken place at Medical City Dallas Hospital. Dr. Todd M. Dewey, Cardiothoracic Surgeon at Medical City Dallas Hospital comments, “After the recent commercial introduction of transcatheter heart valves in the United States, we are now able to offer heart valve implantations to a group of patients for whom the risks associated with open heart surgery are too high. The implantation of a heart valve via a catheter has the advantage of being minimally invasive, but it demands high-quality imaging and precise navigation to ensure accurate positioning. HeartNavigator gives us a much better view of the procedure, which aids us in the preparation of the procedure as well as the execution.”
Philips’ innovative HeartNavigator is a new procedure planning and image guidance tool to assist interventional cardiologists and cardiac surgeons perform minimally invasive heart valve replacements. Developed in co-operation with partner hospitals around the world, HeartNavigator is designed to simplify planning, device selection and projection angle selection in preparation for the procedure and during the procedure itself, HeartNavigator provides live image guidance to support the user in positioning a device.
Dr. H. Schröfel, Senior Cardiac Surgeon at the Karlsruhe Heart Surgery Clinic, Germany says, “I plan all my cases with the HeartNavigator. I trust the measurements with HeartNavigator more than the measurements provided by the normal CT scan.” To date, a total of 895 transcatheter aortic heart valve replacement procedures have been formed at the Karlsruhe Heart Surgery Clinic.
Conventional image guidance software often involves many tedious manual calculations that have to be performed in the control room. HeartNavigator provides automated planning to help simplify complex structural heart disease procedures. It creates an excellent 3D image from previously acquired 2D CT datasets; these 2D datasets are reconstructed to 3D volume-rendered data which are overlaid with the live fluoro image to provide real-time 3D insight during the procedure. With one click, the heart is automatically segmented to visualise anatomical structures and landmarks. Virtual device templates can then be used to assess and select the appropriate device size and the best projection for the patient’s individual anatomy.
Usually, multiple, low-contrast aortograms are used to select the optimal plane for device deployment. The HeartNavigator image visualises the aortic root in various ways, as well as showing the calcification distribution. The software then determines the best projection for the procedure and if required, additional projections can be stored.
During the procedure, the live fluoroscopy image is matched with the 3D image of the ascending aorta to show the exact position of all catheters and devices in relation to the reference image. This provides more guidance and information to check the size of the device and its correct position, and after placement, its position can be evaluated while the patient is still on the table.
HeartNavigator is integrated with Philips Allura Xper X-ray systems, so that the various X-ray views can be stored and recalled on the system, which will automatically move to that projection. The C-arc moves to the X-ray projection chosen, and vice-versa, the 3D image automatically follows the orientation of the C-arc in real-time. The overlay image of the 3D image data and live fluoroscopy are shown on a separate monitor, in addition to the normal monitor, which shows just the live fluoro image.
“Over the years, we have introduced innovative solutions that have helped to simplify minimally invasive procedures and improve patient care”, says Mike Hayden, Sales Director Imaging, Philips Healthcare UK & Ireland. “Philips is committed to expanding its offering in new and growing minimally invasive clinical applications such as structural heart repair and to maintaining our leadership position in interventional cardiology through continuous innovation and collaboration.”
Graphic shows steps 1 to 4 – simple real-time guidance