Angiography Imaging Software Simplifies Workflow for Minimally Invasive Heart Valve Implantation

New image processing software has been developed that helps cardiologists and cardiac surgeons prepare and perform transcatheter aortic valve implantations (TAVIs). Syngo Aortic ValveGuide automatically reconstructs a three-dimensional (3D) representation of the aortic root from computed tomography (CT)-like cross-sectional images acquired with the angiography system.

The software, developed by Siemens Healthcare (Erlangen, Germany), selects anatomic landmarks such as the coronary ostia, for instance, and overlays the 3D image with two-dimensional images acquired during live fluoroscopy. In this manner, the physician obtains real-time, 3D guidance in the patient's body while navigating the new valve to its desired location.

During the minimally invasive TAVI intervention, an artificial aortic valve is inserted via the femoral artery or through the apex of the heart. The new image processing software from provides the physician automated 3D guidance for the procedure and segments the aortic root in three-dimensional mode from Syngo DynaCT cardiac images.

With the aid of anatomic landmarks in the 3D representation of the vessel, Syngo Aortic ValveGuide calculates the exact perpendicular view on the aortic root. The C-arm adjusts to the corresponding angulations for live fluoroscopy. That way, it provides the proper perspective that the physician requires to precisely position the new valve. Consequently, as soon as the software overlays the 3D image of the aorta with the two-dimensional live fluoroscopy, the cardiologist in the cath lab or, respectively, the heart surgeon in the hybrid room, can start the intervention. Since Syngo Aortic ValveGuide only requires a short fluoroscopy time prior to the procedure, the patient's exposure to radiation and contrast agent can be reduced considerably.

The Heart Center in Leipzig, one of the leading facilities in Germany to perform TAVI-procedures, had previously performed several of these interventions with the Syngo DynaCT Cardiac, also developed by Siemens Healthcare. This software processes CT-like images of the heart from images acquired with the angiography system. However, to overlay live fluoroscopy images with these 3D images and find the correct angulation for the C-arm, the physician had to leave the sterile operating area and perform manual angulation calculations at a workstation or make medical staff available solely for this purpose.

"With Syngo Aortic ValveGuide, we can now find the optimal angulation with a perpendicular view on the aortic root easier and faster than before, because the software automates so many work steps,” said Dr. Jörg Kempfert, heart surgeon at the Heart Center Leipzig.

The product is not yet commercially available, and due to regulatory reasons, its future availability cannot be guaranteed. The outcomes achieved by the Siemens customers were achieved in the customer's unique setting. Since there is no "typical” hospital and many variables exist (e.g., hospital size, case mix, level of information technology [IT] adoption) there can be no guarantee that others will achieve the same results. The Heart Center of the University Leipzig has a cooperation contract with Siemens Healthcare.

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