Preprocedural simulation of a mitral transcatheter edge-to-edge repair using computed tomography imaging

Abstract

Abstract Mitral transcatheter edge-to-edge repairs (TEERs) are a widespread treatment option for heart failure complicated with mitral regurgitation. Although we generally use trans-oesophageal echocardiography (TOE) to understand structural heart disease conditions, TOE does not provide a complete view of the heart and surrounding structures. As the TEER device moves in complex ways during the procedure, it is difficult to imagine the actual behavior of the device only from the images obtained from TOE because of its restricted angle of view. Contrast-enhanced CT, on the other hand, is a modality that can capture the image of the heart as a whole, as if looking at a bird’s eye view. The purpose of our study was to create a TEER device simulator using ECG-gated computed tomography imaging. As the first step, we created a virtual inferior vena cava and fossa ovalis model. We obtained 192 possible CT image patterns of the TEER device with this model, and they all were extracted into an STL file format. As the second step, the ECG-gated cardiac CT images of the patients were segmented into each cardiac structure and also extracted into STL files. Finally, both STL file images were fused by some 3D software, and we made a simulation of the TEER procedure preoperatively. By piling up each knob operation and rotation, we could reproduce the serial movement of the TEER device. We could successfully reproduce the TEER device with each knob operation and rotation on a patient-specific cardiac CT image. The positional relationship between the heart and device were visualized, showing the entire trajectory of the device. It could also allow preoperative simulations to be tailored to each patient. Compared to some previous reports about TEER simulations using 3D printing models, our method could save time and cost 1)2). Another report demonstrated a simulator using a cardiac CT image, but that report did not mention how to obtain the device image 3). Our method would be more precise because our simulator was based on real TEER device images. We will apply this method for upcoming real cases and will then confirm whether a preoperative simulation of the ideal manipulation would enable optimal clipping. We successfully created a prototype of a TEER simulator using ECG-gated computed tomography imaging.en face view of the mitral valve (TOE)en face view (simulator)