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Danilov VV, Klyshnikov KY, Gerget OM, Skirnevsky IP, Kutikhin AG, Shilov AA, Ganyukov VI, Ovcharenko EA. Aortography Keypoint Tracking for Transcatheter Aortic Valve Implantation Based on Multi-Task Learning. Front Cardiovasc Med 2021; 8:697737. [PMID: 34350220 PMCID: PMC8326378 DOI: 10.3389/fcvm.2021.697737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/10/2021] [Indexed: 11/15/2022] Open
Abstract
Currently, transcatheter aortic valve implantation (TAVI) represents the most efficient treatment option for patients with aortic stenosis, yet its clinical outcomes largely depend on the accuracy of valve positioning that is frequently complicated when routine imaging modalities are applied. Therefore, existing limitations of perioperative imaging underscore the need for the development of novel visual assistance systems enabling accurate procedures. In this paper, we propose an original multi-task learning-based algorithm for tracking the location of anatomical landmarks and labeling critical keypoints on both aortic valve and delivery system during TAVI. In order to optimize the speed and precision of labeling, we designed nine neural networks and then tested them to predict 11 keypoints of interest. These models were based on a variety of neural network architectures, namely MobileNet V2, ResNet V2, Inception V3, Inception ResNet V2 and EfficientNet B5. During training and validation, ResNet V2 and MobileNet V2 architectures showed the best prediction accuracy/time ratio, predicting keypoint labels and coordinates with 97/96% accuracy and 4.7/5.6% mean absolute error, respectively. Our study provides evidence that neural networks with these architectures are capable to perform real-time predictions of aortic valve and delivery system location, thereby contributing to the proper valve positioning during TAVI.
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Affiliation(s)
- Viacheslav V. Danilov
- Research Laboratory for Processing and Analysis of Big Data, Tomsk Polytechnic University, Tomsk, Russia
| | - Kirill Yu. Klyshnikov
- Department of Experimental Medicine, Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | - Olga M. Gerget
- Research Laboratory for Processing and Analysis of Big Data, Tomsk Polytechnic University, Tomsk, Russia
| | - Igor P. Skirnevsky
- Research Laboratory for Processing and Analysis of Big Data, Tomsk Polytechnic University, Tomsk, Russia
| | - Anton G. Kutikhin
- Department of Experimental Medicine, Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | - Aleksandr A. Shilov
- Department of Experimental Medicine, Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | - Vladimir I. Ganyukov
- Department of Experimental Medicine, Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | - Evgeny A. Ovcharenko
- Department of Experimental Medicine, Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
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Komatsu I, Tang GHL, Leipsic J, Webb JG, Blanke P, Mackensen GB, Kitamura M, Wolak A, Don CW, McCabe JM, Rumer C, Tan CW, Levin DB, Ramos M, Aldea GS, Reisman M, Wijeysundera HC, Radhakrishnan S, Sathananthan J, Piazza N, Kornowski R, Abdel-Wahab M, Dvir D. Distribution of C-arm projections in native and bioprosthetic aortic valves cusps: Implication for BASILICA procedures. Catheter Cardiovasc Interv 2020; 97:E580-E587. [PMID: 32894804 DOI: 10.1002/ccd.29224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 07/15/2020] [Accepted: 08/06/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES We sought to document aortic cusps fluoroscopic projections and their distributions using leaflet alignment which is a novel concept to optimize visualization of leaflets and for guiding BASILICA (bioprosthetic or native aortic scallop intentional laceration to prevent coronary artery obstruction) and determine whether these projections were feasible in catheter laboratory. BACKGROUND Optimal fluoroscopic projections of aortic valve cusps have not been well described. METHODS A total of 128 pre-transcatheter aortic valve replacement (pre-TAVR) computed tomographies (CT) (72 native valves and 56 bioprosthetic surgical valves) were analyzed. Using CT software (3Mensio, Pie medical imaging, the Netherlands), leaflet alignment was performed and the feasibility of these angles, which were defined as rate of obtainable with efforts (within LAO/RAO of 85° and CRA/CAU of 50°) were evaluated. RESULTS High feasibility was seen in right coronary cusp (RCC) front view (100%) and left coronary cusp (LCC) side view (99.2%), followed by noncoronary cusp side view (95.3%). In contrast, low feasibility of RCC side view (7.8%) and LCC front view (47.6%) was observed. No statistical differences were seen between the distribution of native valves and bioprosthetic surgical valves. With patient/table tilt of 20°LAO and 10°CRA, the feasibility of RCC side view and LCC front view increased to 43.7 and 85.2%, respectively. CONCLUSION Distributions of each cusp's leaflet alignment follows "sigmoid curve" which can provide better understanding of aortic valve cusp orientation in TAVR and BASILICA. RCC side view used in right cusp BASILICA is commonly unachievable in catheter laboratory and may improve with patient/table tilt.
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Affiliation(s)
- Ikki Komatsu
- Division of Cardiology, University of Washington, Seattle, Washington
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Medical Center, New York, New York
| | - Jonathon Leipsic
- Department of Radiology, St Paul's Hospital & University of British Columbia, Vancouver, British Columbia, Canada
| | - John G Webb
- Center for Heart Valve Innovation, St Paul's Hospital, Vancouver, British Colombia, Canada
| | - Philipp Blanke
- Department of Radiology, St Paul's Hospital & University of British Columbia, Vancouver, British Columbia, Canada
| | - G Burkhard Mackensen
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
| | | | - Arik Wolak
- Cardiology Department, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Creighton W Don
- Division of Cardiology, University of Washington, Seattle, Washington
| | - James M McCabe
- Division of Cardiology, University of Washington, Seattle, Washington
| | - Christopher Rumer
- Division of Cardiology, University of Washington, Seattle, Washington
| | - Christina W Tan
- Division of Cardiology, University of Washington, Seattle, Washington
| | - Dmitry B Levin
- Division of Cardiology, University of Washington, Seattle, Washington
| | - Mario Ramos
- Division of Cardiology, University of Washington, Seattle, Washington
| | - Gabriel S Aldea
- Division of Cardiovascular surgery, University of Washington, Seattle, Washington
| | - Mark Reisman
- Division of Cardiology, University of Washington, Seattle, Washington
| | | | - Sam Radhakrishnan
- Department of Cardiology, Sunnybrook Health Sciences Center, Toronto, Canada
| | | | - Nicolo Piazza
- Department of Medicine, Division of Cardiology, McGill University, Montreal, Quebec, Canada
| | - Ran Kornowski
- Division of Interventional Cardiology, Rabin Medical Center, Petah Tikva, Israel
| | | | - Danny Dvir
- Division of Cardiology, University of Washington, Seattle, Washington
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