“Persistent Contrast”-Guided Transcatheter Aortic Valve Implantation: Feasibility and Safety of a Vessel Projection Roadmap Technology

Objectives: Valve deployment remains the most critical phase during transcatheter aortic valve implantation (TAVI). We investigated the application feasibility and safety of a novel software tool designed for the visualization of the aortic root during TAVI.

Methods: The Philips “Persistent Contrast” prototype application was used during balloon expandable Edwards Lifesciences SapienXT valve deployment. It processes any angiographic sequences, extracting the static outline of vessels and projecting the two-dimensional vessel margins as a roadmap on live fluoroscopy. Pre-operational planning, sizing and anatomical assessment of access routes were performed using computed tomography scans and the Philips “HeartNavigator” software.

Results: 15 high-risk aortic stenosis patients (mean age 82.0 ± 6.6 years) underwent TAVI via transfemoral (n = 8), transapical (n = 4), and transaortic (n = 3) access routes. Mean logistic EuroScores and STS-scores were 19.7 ± 4.3% and 7.9 ± 3.1%, respectively, mean aortic gradient was 66.3 ± 18.3 mm Hg. All valves were implanted successfully with none or trivial paravalvular regurgitation in 11 patients, mild in 3 patients, and moderate in 1 patient. Complete atrioventricular block was observed in 1 patient. TAVI was performed in all cases with only one aortic root contrast media injection during valve deployment. No major stroke or cardiovascular death occurred within 30 days.

Conclusion: Persistent contrast-guided implantation of the SapienXT valve is safe and feasible. This new feature might increase the accuracy of valve placement and also may reduce the need for extra contrast media use during valve deployment. However, the lack of real-time motion compensation limits its wide application, as the overlay does not move together with respiratory and cardiac motion.

No conflict of interest has been declared by the author(s).