Transcatheter aortic valve replacement becomes the topics as low invasive surgery for the high-risk aortic stenosis worldwide. The AVI Support prototype was introduced in our institution, and is used for 3D-Navigation system. The purpose of this study is to examine the optimization and usefulness of the 3D-Navigation system in TAVR.
In this study, I evaluated the 3D reconfiguration image by the difference in Dyna-CT imaging condition,and the gap of the most suitable angle calculated from AVI Support prototype and preoperatine images. And also I elucidated clinical impacts.
Regarding 3D reconfiguration image, reduction of the contrast media consumption is possible by the triple attenuant imaging with the saline, I could secure enough imaging in clinical. In addition, Iconfirmed improvement of a picture by rapid-pacing and breath-holding. Some gaps occurred between the most suitable angle calculated from AVI Support prototype and preoperatine images.
In conclusion, the AVI Support prototype got the most suitable angle calculation so quickly. In addition, the AVI Support prototype is the very useful tool to get precise three dimensional image, furthermore it may be able to reduce total contrast media consumption.

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A new technology called estimated continuous cardiac output (esCCO) uses pulse wave transit time (PWTT) obtained from an electrocardiogram and pulse oximeter to measure cardiac output (CO) noninvasively and continuously. This study was performed to evaluate the accuracy of esCCO during exercise testing. We compared esCCO with CO measured by echo Doppler aortic velocity-time integral (VTIao_CO). The correlation coefficient between esCCO and VTIao_CO was r = 0.87 (n = 72). Bias and precision were 0.33 ± 0.95 L/min with a percentage error of 30.2%. And the correlation coefficient between change in esCCO and change in VTIao_CO was r = 0.75 (n = 70). The esCCO could detect change in VTIao_CO larger than 1 L/min with a concordance rate of 88.2%. The areas under ROC curves to detect VTIao_CO changes more than 15% and 30% were 0.81 and 0.91, respectively. Polar plots show that the mean polar angle was 2.2° and radial limits of agreement were ±43.6°. The trending ability of esCCO is comparable with that of currently available arterial waveform analysis methods. In this study, the validity of esCCO during exercise testing was assessed and shown to be acceptable with respect to agreement and trending ability compared with the echo Doppler.

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Half a decade has passed since the fifth revision of the medical law on April 1st, 2007. In this period, circumstances have changed regarding maintenance of medical equipments. We conducted a questionnaire survey to screen these changes and the current situation in the medical equipments management. The questionnaire was sent to 356 general hospitals with more than 300 beds in the Kanto region, and 159 responses were received (44.7%). The questionnaire asked information on the number of full-time clinical engineers (CEs) working on maintenance, the numbers of medical equipments maintained in each hospital, the occupation of the appointed medical equipment safety manager (MESM), the role of the MESM, and thoughts on the responsibilities of the MESM. Over the past five years, maintenance of medical equipments increased in 69% of the hospitals. The number of CEs increased in 30% of the hospitals and the average number of full-time CEs maintaining medical equipments was 2.9. The appointed MESM was a CE or physician in many hospitals. Operation managers were placed in each section in hospitals in which a physician was appointed as the MESM. Many answers pointed out that it was difficult for one person to cover all of the requirements to the MESM. This suggests that it is appropriate and useful for operation managers for medical equipments to work under the MESM.

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