P950 Impact of True Vue-Trans- Illumination rendering imaging for intraoperative echocardiography in a wide range of interventions

Abstract

Abstract Background Volume rendering methods have been improved to further enhance the quality of imaging and make the communication between echocardiographers and interventionists more fast, reliable and simple. The last innovation in this field is the "3D Real Time True Vue-Transillumination (TI)" rendering method. This allows to freely move virtual light inside a sample volume to enhance image details and depth. No studies have addressed the advantage of this method in the context of procedural guidance for structural interventions. Purpose The aim of the present paper is to test the advantages of this method when applied to interventional TOE during cardiac structural interventions. Methods During different procedures we prospectively collected the apparent added value of TI compared to conventional rendering scored independently by two cardiologists in charge of procedural guidance, one being in training (observer 1) and one trained (observer 2). The score was performed in a Likert scale from 1 to 5 with refer to advantage of TI for different procedural concerns (from 1 that meant "strongly disagree" to 5 "strongly agree"). We tested the inter-rater reliability with the K coefficient of agreement between the two observers. In this analysis we included multiple procedural targets to be imaged during different procedures. Results We included 8 complex procedures performed in our institutions between November 2018 and March 2019 and collected the agreement of the two observers about the following procedural concerns: evaluation of MV area for MV repair procedures; evaluation of MV main target lesion at the beginning of repairing procedure for procedural planning; evaluation of calcifications of MV leaflet and annulus and cleft for patients selection; evaluation of device trajectory with 3D real time imaging before crossing the valve plane during orienting manoeuvre; assessment of residual lesion after first clip for procedural decision making; evaluation of para-valvular leak: site and amount;evaluation of inch point of leaflets for direct annuloplasty in mitral valve and tricuspid valve regurgitation; visualization of coronary sinus during the implant of anchors of Cardioband in posterior part of tricuspid annulus. We collected the scores for a total of 13 records. The 2 observers perceived an added value for TI for all the procedural concerns analysed (mean score of 4.0 ± 0,75); a good agreement was obtained about the superiority of TI rendering in these 13 concerns with a Kappa coefficient of inter-agreement of 0.71, p < 0.0001. Conclusions this is the first experience comparing the new 3D TI rendering with 3D conventional rendering in the context of intra-procedural guidance for structural valve interventions. We obtained good inter-agreement between two echocardiographist with different levels of experience suggesting that TI may have advantages even for education.