Tomorrow’s cath lab will see an integration of today’s most advanced technologies, and the result will be much more than the sum of its parts.
Cardiac catheterization is one of the most widely performed cardiac procedures. As expected, in any invasive procedure, there are some patient-related and procedure-related complications. With significant advances in the equipment used for cardiac catheterization, the improved skill of the operators, and newer techniques, the rates of these complications have been reduced significantly.
Indeed, today image-guided interventions have become the treatment of choice for a broad range of diagnoses, thanks to their minimally invasive nature. But even with the success achieved with widespread dissemination of these technologies and techniques, there remains significant opportunity to improve technology and techniques, to access and treat more patients, and to do so more safely and with even greater clinical success.
Angiographic-imaging system vendors have developed several new technologies to address emerging cath lab trends, including the need to reduce radiation dose, improve image quality, and enable advanced procedural image guidance. All three of these points have become increasingly important as more complex procedures are attempted in interventional cardiology cath labs and hybrid ORs. These procedures include transcatheter aortic valve replacement (TAVR), MitraClip repairs, left atrial appendage (LAA) occlusions, atrial and ventricular septal defect closures, and new interventions for both electrophysiology (EP) and heart failure.
All of the major vendors have introduced new systems and technologies in the past few years to reduce dose, and enhance visualization in the cath lab. The vendors have tailored their systems into various models for specific specialties and at various price points, depending on the degree of functionality. Most vendors also offer software to enhance visualization of stents and other devices.
Advances in cath lab technology are so fast paced that any new state-of-the-art cath lab starts looking old in less than 5 years. A cath lab now means much more than a fluoroscopy unit. Vascular imaging has become an integral part of any cath lab setup.
Robots in the cath lab. Surgical and interventional robotic systems have already made a significant impact. Just as the da Vinci system has facilitated minimally invasive therapies, which previously could only be done invasively, the Hansen Magellan and Corindus systems have demonstrated the capability to perform interventional procedures with vastly decreased operator radiation exposure. They are joined by startup companies like Restore Surgical who are developing more compact, cost-effective, and workflow-compatible robotic solutions.
The industry is now at the verge of expanding these technologies and truly realizing robot-assisted procedures, in which clinicians are given mechanical and navigational tools that allow certain actions or portions of the procedure to be performed autonomously, with a level of control only possible with robotics.
Integration of augmented reality. A new technology that is already on the horizon to aid procedural navigation in the cath lab is augmented reality (AR). The technology enables operators to see true 3D images of anatomy in a heads-up display while they are looking at the patient or at the main screen in the lab. Manufacturers are showing a conceptual work-in-progress of this technology and some have already commercialized AR technology to aid in advanced visualization of patient 3D datasets. AR allows physicians to view, measure, and manipulate real-time holographic images of the patient’s heart during procedures, while still being able to clearly see around the room. Using real-time navigation data feeds rather than MRI or CT, the solution provides clinicians with patient-specific anatomy in a holographic display, including catheter movement. The software is aimed at reducing operating time and radiation exposure to clinicians, and potentially improving outcomes for patients.
Predictive analytics. Predictive analytics allow the mining of vast amounts of data to extract information and patterns, which can provide valuable guidance to clinicians. One reason that the highest-volume practitioners are also the highest-performing is that they are able to draw upon the greatest pools of experiential knowledge. Analytics will allow us to spread this wealth. The widespread use of electronic medical records (EMRs) has set the stage for this type of technology, the most significant remaining piece is to encode data regarding anatomy. The development of technologies capable of transforming imaging data into models suitable for computerized analysis will close this gap and allow computational systems to provide valuable clinical decision support.
Reducing use of X-ray image navigation. Advanced forms of imaging with reduced dependence on ionizing radiation are becoming increasingly available. Navigation technologies are allowing improved 3D visualization while also reducing dependence on fluoroscopy. Advanced imaging combined with robotic control will provide increasingly precise image guidance, as well as increasingly precise interventional control. Predictive analytics will allow machine learning algorithms to provide optimal robotic navigation, and to augment imaging with the most clinically relevant and useful additional information.
Holographic procedural navigation. In addition to augmented reality, live, 3D, transesophageal echo (TEE) holographic imaging can be projected in the cath lab now without the need for special glasses or AR visors. Recently, EchoPixel showed how a GE TEE system can project holograms of live views of heart valves or the left atrial appendage (LAA) using a special display screen. A couple of large angiography-system vendors are looking at the system for possible integrations with their own technologies. It may soon be possible to direct LAA occlusions or MitraClip implants using holograms and eliminate the need to have three different 2D echo views so the operators can reconstruct the 3D image in their brain. The holograms will make visualization much easier and intuitive for device deployments.
Tomorrow’s cath lab will see an integration of today’s most advanced technologies, and the result will be much more than the sum of its parts. This will facilitate continued growth of the capabilities and reach of catheter-based interventional therapies, allowing a greater patient population to be treated with greater success. It will empower clinicians to make the best possible decisions for patients and to protect themselves and their patients from undesired exposure to radiation in imaging. Especially, as we see advances in interventional structural heart therapies, complex percutaneous coronary interventions, and endovascular aortic repair (EVAR), this synergy will create value for clinicians, patients, and the healthcare system alike.