Adult cardiac & structural heart: VR and AR surgical planning research

“Preoperatively, XR has been shown to evaluate mitral annular pathology more accurately than echocardiography, informing the surgeon about the optimal surgical technique, approach and plan for a particular patient's MV pathology.”

“The incorporation of 3D reconstruction modeling has significantly enhanced our understanding of patient anatomy and morphology, thereby improving diagnostic accuracy and patient outcomes.”

“Our review highlights the need for a robust assessment of the effectiveness of the methods and discusses the technical limitations that hinder the complete integration of AR and VR in cardiology, including cost-effectiveness and regulatory compliance.”

“At least 33 XR systems have been described, with many demonstrating proof of concept, but with no specific mention of regulatory approval including some prospective studies.”

“Persistent technical challenges to overcome include the integration of different imaging modalities into VR/AR and the harmonization of data flow and interfaces.”

“The HJPHub system enabled three-dimensional assessment of complex anatomy, facilitating optimal transseptal puncture site selection.”

“Consistent with the VR-based prediction, residual potentials were subsequently identified at the left PV carina on high-density mapping and were successfully eliminated with additional applications.”

“Feedback highlighted its comfort, confidence enhancement, and user-friendliness.”

“The incision site marking made using HoloLens® 2 differed by one intercostal space from the marking made using a conventional surgeon's mental reconstructed image from the patient's preoperative imaging and was found to be a more appropriate site of entry”

“In Patient 1, virtual reality simulation revealed that, according to the distance and angulation from the annulus, the ideal puncture site was the second intercostal space.”

“Cardiac surgeons highly rated the visualization tool for its utility in preoperative planning, with a mean Likert score of 4.57/5.0 (SD 0.5).”

4.57/5.0

“Furthermore, the mixed-reality app has confirmed the potential of this technology in diagnostic and preoperative planning, although some limitations should still be overcome.”

“Processed images and virtual reality showed intense adherences of the leads to the veins, right ventricle, and right atrium endocardium and between them that preclude a difficult extraction and required a carefully planning and sometimes a different technical approach.”

“Both preoperatively and intraoperatively, the tool augmented spatial orientation and facilitated precise stenosis localization, thereby enhancing the surgeon's operative proficiency.”

“Findings demonstrated that augmented exploration of cardiac biomechanics can be used for a better understanding of the electrical field of the beating heart.”

“From November 2019 until February 2022, 53 3D virtual biomodels were produced for intervention planning (using Virtual/Augmented Reality and/or 3D printing), following a specific segmentation and preprocessing workflow for biomodelling, in patients with advanced heart failure due to structural heart disease or cardiomyopathies.”

“In 33% of cases (two out of six), the preoperative decision was adjusted due to the 3D VR-based evaluation of the anatomy.”

33%

“The morphological analysis of the holographic anatomical models was successfully applied for all the patients (n ​= ​4) independently from the morphology and it was performed in less than 10 minutes.”

less than 10 minutes

“Preoperative planning in VR alleviated concerns regarding obstruction of the neo-LVOT and helped confirm safe implantation by clearly showing the three-dimensional spatial relationship between the implants and surrounding patient anatomy.”

“The surgical strategy was adjusted in 11.8% of the cases due to the 3-dimensional virtual reality-based anatomy evaluation.”

11.8%

“After preprocedural simulation using virtual reality, we successfully completed box-lesion, ablation line from superior vena cava to inferior vena cava, left atrial appendage (LAA) excision, and PLSVC ablation.”

“Our study demonstrates that immersive 3D VR visualization of anatomy might be beneficial as a supplementary preoperative planning tool for cardiothoracic surgery, and further research on this topic may be considered to implement this innovative tool in daily clinical practice.”

“The experimental results show that, with the use of ARS-CADPT, the reconstruction accuracy of CAV model is high, the HCI is natural and fluent, and the visual effect is good.”