Learning three-dimensional aortic root assessment based on sparse annotations.

Purpose: Analyzing the anatomy of the aorta and left ventricular outflow tract (LVOT) is crucial for risk assessment and planning of transcatheter aortic valve implantation (TAVI). A comprehensive analysis of the aortic root and LVOT requires the extraction of the patient-individual anatomy via segmentation. Deep learning has shown good performance on various segmentation tasks.

Outcomes and survival following thoracic endovascular repair in patients with aortic aneurysms limited to the descending thoracic aorta.

Background: Thoracic endovascular aortic repair (TEVAR) is a well-established therapy for descending aortic aneurysms (DTA). There is a paucity of large series reporting the mid- and long-term outcomes from this era. The main aim of this study was to evaluate the outcomes of TEVAR with regards to the effect of aortic morphology and procedure-related variables on survival, reintervention and freedom from endoleaks.

Pre-Glenn aorto-pulmonary collaterals in single-ventricle patients.

Background: In single-ventricle patients undergoing staged-bidirectional Glenn, 36-59% have aorto-pulmonary collateral flow, but risk factors and clinical outcomes are unknown. We hypothesise that shunt type and catheter haemodynamics may predict pre-bidirectional Glenn aorto-pulmonary collateral burden, which may predict death/transplantation, pulmonary artery or aorto-pulmonary collateral intervention.

Methods: Retrospective cohort study of patients undergoing a Norwood procedure for single-ventricle anatomy.

Aortic remodelling and late outcomes following thoracic endovascular repair with a bare-metal stent distal extension among patients with complicated type-B aortic dissection.

Objectives: The goal of this study was to describe the factors affecting mid and late aortic remodelling following thoracic endovascular aortic repair with the PETTICOAT (Provisional Extension To Induce Complete Attachment) technique among patients with complicated acute or subacute type B aortic dissection.

Methods: A retrospective single-centre study that evaluates clinical and morphological outcomes among 65 consecutive patients. The area and diameter of the true and false lumen, overall aortic diameter and false lumen perfusion were evaluated.

Tricuspid valve repair concomitant with the Norwood operation among babies with hypoplastic left heart syndrome.

Objectives: Among patients with hypoplastic left heart syndrome (HLHS), tricuspid valve regurgitation (TR) portends a poor prognosis. Our goal was to describe the outcomes of tricuspid valve reconstruction (TVR) concomitant with the Norwood operation and using two-dimensional echocardiography and evaluate the structural factors associated with successful functional correction.

Methods: We performed a retrospective, single-centre study of patients with HLHS undergoing TVR at the time of the Norwood operation.

Cascaded neural network-based CT image processing for aortic root analysis.

Purpose: Careful assessment of the aortic root is paramount to select an appropriate prosthesis for transcatheter aortic valve implantation (TAVI). Relevant information about the aortic root anatomy, such as the aortic annulus diameter, can be extracted from pre-interventional CT. In this work, we investigate a neural network-based approach for segmenting the aortic root as a basis for obtaining these parameters.

The feasibility of mitral valve device foldoplasty: an in vivo study to evaluate durable retention.

Objectives: We have previously shown in experimental settings that a leaflet foldoplasty device reduces redundant leaflet area to re-establish mitral valve (MV) coaptation. The current study investigates the in vivo device retention and functional durability following foldoplasty.

Methods: The prototype is of superelastic nitinol formed into a 3-dimensional shape.

Infrastructure Availability for the Care of Congenital Heart Disease Patients and Its Influence on Case Volume, Complexity and Access Among Healthcare Institutions in 17 Middle-Income Countries.

The care for patients with congenital heart disease (CHD) is multi-disciplinary and resource intensive. There is limited information about the infrastructure available among programs that care for CHD patients in low and middle-income countries (LMIC). A survey covering the entire care-pathway for CHD, from initial assessment to inpatient care and outpatient follow-up, was administered to institutions participating in the International Quality Improvement Collaborative for Congenital Heart Disease (IQIC).

Importance of Preserved Tricuspid Valve Function for Effective Soft Robotic Augmentation of the Right Ventricle in Cases of Elevated Pulmonary Artery Pressure.

Purpose: In clinical practice, many patients with right heart failure (RHF) have elevated pulmonary artery pressures and increased afterload on the right ventricle (RV). In this study, we evaluated the feasibility of RV augmentation using a soft robotic right ventricular assist device (SRVAD), in cases of increased RV afterload.

Methods: In nine Yorkshire swine of 65-80 kg, a pulmonary artery band was placed to cause RHF and maintained in place to simulate an ongoing elevated afterload on the RV.

Real-time intraoperative co-registration of transesophageal echocardiography with fluoroscopy facilitates transcatheter mitral valve-in-valve implantation in cases of invisible degenerated bioprosthetic valves.

Objectives: Transcatheter mitral valve-in-valve (TMViV) implantation is an alternative treatment to surgery for high-risk patients with degenerated bioprosthetic mitral valves. Some types of bioprostheses are fluoroscopically translucent, resulting in an 'invisible' target deployment area. In this study, we describe the feasibility and outcomes of this procedure using intraoperative fusion of transoesophageal echocardiography (TEE) and live fluoroscopy to facilitate valve deployment in cases of invisible bioprosthetic valves.

Interactive editing of virtual chordae tendineae for the simulation of the mitral valve in a decision support system.

Purpose: Decision support systems for mitral valve disease are an important step toward personalized surgery planning. A simulation of the mitral valve apparatus is required for decision support. Building a model of the chordae tendineae is an essential component of a mitral valve simulation.

Dynamic Augmentation of Left Ventricle and Mitral Valve Function With an Implantable Soft Robotic Device.

Left ventricular failure is strongly associated with secondary mitral valve regurgitation. Implantable soft robotic devices are an emerging technology that enables augmentation of a native function of a target tissue. We demonstrate the ability of a novel soft robotic ventricular assist device to dynamically augment left ventricular contraction, provide native pulsatile flow, simultaneously reshape the mitral valve apparatus, and eliminate the associated regurgitation in an Short-term large animal model of acute left ventricular systolic dysfunction.

Combining position-based dynamics and gradient vector flow for 4D mitral valve segmentation in TEE sequences.

Purpose: For planning and guidance of minimally invasive mitral valve repair procedures, 3D+t transesophageal echocardiography (TEE) sequences are acquired before and after the intervention. The valve is then visually and quantitatively assessed in selected phases. To enable a quantitative assessment of valve geometry and pathological properties in all heart phases, as well as the changes achieved through surgery, we aim to provide a new 4D segmentation method.

Endovascular treatment of acute type A aortic dissection in a nonagenarian: stabilization of a short covered stent using a bare-metal stent.

Endovascular treatment is a viable alternative therapy in high-risk patients with acute type A aortic dissection. However, the optimal endovascular treatment strategy is still evolving. Herein, we present a case of a 91-year-old man who successfully underwent repair of an ascending aortic dissection using a stent-in-stent technique.

Simulation of a Right Anterior Thoracotomy Access for Aortic Valve Replacement Using a 3D Printed Model.

Objective: The right anterior lateral thoracotomy (RALT) approach for aortic valve replacement provides excellent outcomes in expert hands while avoiding sternal disruption. It, however, remains a technically demanding niche operation. Instrument trajectories via this access are influenced by patient anatomy, the intercostal space chosen, and surgical retraction maneuvers.

User-dependent variability in mitral valve segmentation and its impact on CFD-computed hemodynamic parameters.

Purpose: While novel tools for segmentation of the mitral valve are often based on automatic image processing, they mostly require manual interaction by a proficient user. Those segmentations are essential for numerical support of mitral valve treatment using computational fluid dynamics, where the reconstructed geometry is incorporated into a simulation domain. To quantify the uncertainty and reliability of hemodynamic simulations, it is crucial to examine the influence of user-dependent variability in valve segmentation.

A Novel Technique for Transcatheter Aortic Valve Replacement in Pure Aortic Regurgitation.

Transcatheter aortic valve replacement (TAVR) in pure aortic regurgitation (AR) is challenging, because of the subsequent difficulty in anchoring the transcatheter valve in a noncalcified device landing zone (DLZ). Prestenting can help to prepare a stable DLZ for TAVR in pure AR and prevent valve migration. Here we report the first-in-human implantation of an uncovered stent into a noncalcified aortic valve as a prestenting strategy to prepare an easy DLZ for TAVR in pure AR.

Extraction of open-state mitral valve geometry from CT volumes.

Purpose: The importance of mitral valve therapies is rising due to an aging population. Visualization and quantification of the valve anatomy from image acquisitions is an essential component of surgical and interventional planning. The segmentation of the mitral valve from computed tomography (CT) acquisitions is challenging due to high variation in appearance and visibility across subjects.

A leaflet plication clip is an effective surgical template for mitral valve foldoplasty.

Objectives: During mitral valve repair using the foldoplasty technique, correct judgement of the necessary dimensions and orientation of the leaflet fold is a critical but challenging step that can affect the chances of successful repair. In this study, we investigated whether a leaflet plication clip can be used to guide suture foldoplasty for posterior leaflet prolapse of the mitral valve.

Methods: Complete posterior leaflet prolapse was created in both in vivo and ex vivo pig hearts by severing the chordae supporting the middle scallop.

An Implantable Extracardiac Soft Robotic Device for the Failing Heart: Mechanical Coupling and Synchronization.

Soft robotic devices have significant potential for medical device applications that warrant safe synergistic interaction with humans. This article describes the optimization of an implantable soft robotic system for heart failure whereby soft actuators wrapped around the ventricles are programmed to contract and relax in synchrony with the beating heart. Elastic elements integrated into the soft actuators provide recoiling function so as to aid refilling during the diastolic phase of the cardiac cycle.

Soft robotic ventricular assist device with septal bracing for therapy of heart failure.

Previous soft robotic ventricular assist devices have generally targeted biventricular heart failure and have not engaged the interventricular septum that plays a critical role in blood ejection from the ventricle. We propose implantable soft robotic devices to augment cardiac function in isolated left or right heart failure by applying rhythmic loading to either ventricle. Our devices anchor to the interventricular septum and apply forces to the free wall of the ventricle to cause approximation of the septum and free wall in systole and assist with recoil in diastole.

The use of soft robotics in cardiovascular therapy.

Robots have been employed in cardiovascular therapy as surgical tools and for automation of hospital systems. Soft robots are a new kind of robot made of soft deformable materials, that are uniquely suited for biomedical applications because they are inherently less likely to injure body tissues and more likely to adapt to biological environments. Awareness of the soft robotic systems under development will help promote clinician involvement in their successful clinical translation.