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Computational Stent Placement in Transcatheter Aortic Valve Implantation

机译：经导管主动脉瓣植入中的计算支架置入

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摘要

Transcatheter aortic valve implantation (TAVI) is a minimally invasive procedure to treat severe aortic stenosis in patients with a high risk for conventional surgery. In-silico experiments of stent deployment within patient-specific models of the aortic root have created an opportunity to predict stent behavior during the intervention. Current limitations in procedure planning are a primary motivator for these simulations. The virtual stent placement preceding the deployment phase of such experiments has major influence on the outcome of the simulation, but only received little attention in literature up to now. This work presents a methodical approach to patient-specific planning of placement of self-expanding stent models by analyzing experimental outcomes of different sets of boundary conditions constraining the stent. As a results, different paradigms for automated or expert guided stent placement are evaluated, which demonstrate the benefits of virtual stent deployment for intervention planning. To build a predictive planning pipeline for TAVI we use an automatic segmentation of the aorta, aortic root and left ventricle, which is converted to a finite element mesh. The virtual stent is then placed along a guide wire model and deployed at multiple locations around the aortic root. The simulation has been evaluated using pre- and post-interventional CT scans with an average relative circumferential error of 4.0% (±2.5%), which is less than half of the average difference in circumference between individual stent sizes (8.6%). Our methods are therefore enabling patient-specific planning and provide better guidance during the intervention.
机译：经导管主动脉瓣植入术（TAVI）是一种微创手术，用于治疗常规手术高风险患者中的严重主动脉瓣狭窄。在主动脉根的患者特定模型内进行支架部署的计算机模拟实验创造了机会，可以预测介入过程中的支架行为。程序规划中的当前限制是这些模拟的主要动机。在此类实验的部署阶段之前，虚拟支架的放置对模拟结果有重大影响，但到目前为止，在文献中只受到很少的关注。这项工作通过分析约束支架的不同边界条件集的实验结果，提出了一种针对患者的自扩张支架模型放置计划的方法化方法。结果，评估了自动或专家指导的支架置入的不同范例，证明了虚拟支架部署对于干预计划的益处。为了建立TAVI的预测性计划管道，我们使用主动脉，主动脉根部和左心室的自动分割，将其转换为有限元网格。然后将虚拟支架沿导丝模型放置并部署在主动脉根周围的多个位置。使用介入前和介入后CT扫描对模拟进行了评估，其平均相对圆周误差为4.0％（±2.5％），小于单个支架尺寸之间圆周平均差的一半（8.6％）。因此，我们的方法可实现针对患者的计划，并在干预过程中提供更好的指导。

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  • 来源
    《Biomedical simulation》|2014年|95-105|共11页
  • 会议地点 Strasbourg(FR)
  • 作者

    Christoph Russ; Raoul Hopf; Simon H. Suendermann; Silvia Born; Sven Hirsch; Volkmar Falk; Gabor Szekely; Michael Gessat;

  • 作者单位

    Computer Vision Laboratory, ETH Zurich Sternwartstrasse 7, 8092 Zurich, Switzerland;

    Institute of Mechanical Systems, ETH Zurich Tannenstrasse 3, 8092 Zurich, Switzerland;

    Division of Cardiovascular Surgery, University Hospital Raemistrasse 101, 8091 Zurich, Switzerland;

    Hybrid Laboratory for Cardiovascular Technologies, University of Zurich Raemistrasse 101, 8091 Zurich, Switzerland;

    Computer Vision Laboratory, ETH Zurich Sternwartstrasse 7, 8092 Zurich, Switzerland;

    Division of Cardiovascular Surgery, University Hospital Raemistrasse 101, 8091 Zurich, Switzerland;

    Computer Vision Laboratory, ETH Zurich Sternwartstrasse 7, 8092 Zurich, Switzerland;

    Computer Vision Laboratory, ETH Zurich Sternwartstrasse 7, 8092 Zurich, Switzerland,Hybrid Laboratory for Cardiovascular Technologies, University of Zurich Raemistrasse 101, 8091 Zurich, Switzerland;

  • 会议组织
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

    stent placement; virtual deployment; medical simulation; transcatheter aortic valve implantation;

    机译：支架放置；虚拟部署；医学模拟经导管主动脉瓣植入;

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