Recent Developments in Catheter-Based Cardiac Procedures

Patient-specific Cardio-respiratory Motion Prediction in X-ray Angiography using LSTM Networks

Objective.To develop a novel patient-specific cardio-respiratory motion prediction approach for X-ray angiography time series based on a simple long short-term memory (LSTM) model.Approach.The cardio-respiratory motion behavior in an X-ray image sequence was represented as a sequence of 2D affine transformation matrices, which provide the displacement information of contrasted moving objects (arteries and medical devices) in a sequence. The displacement information includes translation, rotation, shearing, and scaling in 2D. A many-to-many LSTM model was developed to predict 2D transformation parameters in matrix form for future frames based on previously generated images. The method was developed with 64 simulated phantom datasets (pediatric and adult patients) using a realistic cardio-respiratory motion simulator (XCAT) and was validated using 10 different patient X-ray angiography sequences.Main results.Using this method we achieved less than 1 mm prediction error for complex cardio-respiratory motion prediction. The following mean prediction error values were recorded over all the simulated sequences: 0.39 mm (for both motions), 0.33 mm (for only cardiac motion), and 0.47 mm (for only respiratory motion). The mean prediction error for the patient dataset was 0.58 mm.Significance.This study paves the road for a patient-specific cardio-respiratory motion prediction model, which might improve navigation guidance during cardiac interventions.

Recent advances in nonoperating room anesthesia for cardiac procedures

PURPOSE OF REVIEW

The number of complex procedures performed in the cardiac catheterization laboratory (CCL) is rapidly increasing. Because of their complexity, they frequently require the assistance of an anesthesiologist. The CCL is primarily designed to facilitate a percutaneous cardiac intervention; therefore, it might be a challenging workplace for an anesthesiologist. The aim of this review is to briefly present tasks and challenges of providing anesthesia in the CCL and to provide a concise description of common cardiac procedures performed there.

RECENT FINDINGS

Recent literature indicates that many complicated cardiac procedures can be performed in CCL under monitored anesthesia care. At the same time several of them (e.g. transcatheter aortic valve replacement) are quickly becoming a viable alternative for surgical valve replacement. The most recent expansion of CCL procedures is related to rapidly growing population of grown-ups with congenital heart disease. All aforementioned developments present new challenges to an anesthesiologist.

SUMMARY

New and fast development of percutaneous cardiac interventions has created a new working place for the anesthesiologist - the CCL. Our expertise in complex cardiac pathophysiology allows conduct of complicated procedures outside of the operating theater. For the same reasons, there is ongoing discussion whether anesthesia support in CCL should be provided by a general or cardiac anesthesiologist.