Automated CTA based measurements for planning support of minimally invasive aortic valve replacement surgery

Mustafa A Elattar; Floortje van Kesteren; Esther M Wiegerinck; Ed Vanbavel; Jan Baan; Riccardo Cocchieri; Bas de Mol; Nils R Planken; Henk A Marquering

doi:10.1016/j.medengphy.2016.11.002

Automated CTA based measurements for planning support of minimally invasive aortic valve replacement surgery

Med Eng Phys. 2017 Jan:39:123-128. doi: 10.1016/j.medengphy.2016.11.002. Epub 2016 Nov 29.

Authors

Mustafa A Elattar¹, Floortje van Kesteren², Esther M Wiegerinck³, Ed Vanbavel⁴, Jan Baan³, Riccardo Cocchieri³, Bas de Mol³, Nils R Planken⁵, Henk A Marquering⁶

Affiliations

¹ Department of Biomedical Engineering and Physics, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. Electronic address: mustafa.elattar@gmail.com.
² Departments of Radiology, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; Department of Heart Center, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
³ Department of Heart Center, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
⁴ Department of Biomedical Engineering and Physics, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
⁵ Departments of Radiology, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
⁶ Department of Biomedical Engineering and Physics, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; Departments of Radiology, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.

PMID: 27913175
DOI: 10.1016/j.medengphy.2016.11.002

Abstract

Minimally invasive aortic valve replacement (mini-AVR) procedures are a valuable alternative to conventional open heart surgery. Currently, planning of mini-AVR consists of selection of the intercostal space closest to the sinotubular junction on preoperative computer tomography images. We developed an automated algorithm detecting the sinotubular junction (STJ) and intercostal spaces for finding the optimal incision location. The accuracy of the STJ detection was assessed by comparison with manual delineation by measuring the Euclidean distance between the manually and automatically detected points. In all 20 patients, the intercostal spaces were accurately detected. The median distance between automated and manually detected STJ locations was 1.4 [IQR= 0.91-4.7] mm compared to the interobserver variation of 1.0 [IQR= 0.54-1.3] mm. For 60% of patients, the fourth intercostal space was the closest to the STJ. The proposed algorithm is the first automated approach for detecting optimal incision location and has the potential to be implemented in clinical practice for planning of various mini-AVR procedures.

Keywords: CT angiograph; Intercostal spaces; Mini-AVR; Segmentation; Sinotubular junction.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Algorithms
Aortic Valve / diagnostic imaging*
Aortic Valve / surgery*
Automation
Computed Tomography Angiography / methods*
Female
Heart Valve Prosthesis Implantation*
Humans
Male
Minimally Invasive Surgical Procedures*