Congenital heart: VR and AR surgical planning research

“Overall, in 14 cases the location of the stent was concordant between the simulation and reality and in the remaining 6 cases the simulated stent was located lower than the actual one.”

“After viewing patient cases on VR, surgeons reported that they would have made minor modifications to surgical approach in 53% and major modifications in 7% of cases.”

53%

“In addition, surgical planning was improved since new observations or different preoperative plans were apparent in 4 out of 7 cases.”

4 out of 7

“We find a significant increase in reported physician confidence in understanding of the patient anatomy from before VR to after (p = 0.012) and identified several common patterns of 3D exploration of the anatomy in VR.”

p = 0.012

“Among surgeons and interventionalists, 82% reported improved procedural planning and 57% altered their procedural approach.”

57%

“Overall, most participants (6/8, 75%) rated the system positively for decision-making support and 5/8 (63%) for complex case preparation.”

6/8, 75%

“Out of these modalities, 76.4% of the specialists ranked VR as the best for understanding the spatial associations between cardiac structures and for presurgical planning.”

76.4%

“The average times for creating 1 bifurcated and 1 tube-shaped graft after a single 10-minute training session were 13.40 and 5.49 minutes, respectively, with 3 out 5 bifurcated and 1 out of 5 tube-shaped graft designs being in the benchmark range of hepatic flow distribution.”

13.40 and 5.49 minutes

“The results showed that the MR models were ranked as the best modality amongst the three, and were significantly better than DICOM images in demonstrating complex CHD lesions (mean difference (MD) = 0.76, p = 0.01)”

p = 0.01

“VR was perceived as more useful in medical education and preoperative planning compared to 3D printed heart models, although there was no significant difference in the ratings (p = 0.54 and 0.35, respectively).”

p = 0.54

“This preliminary study demonstrates that MR holograms as surgical planning tool for congenital heart disease may have a high diagnostic value and contribute to understanding complex morphology.”

“XR technologies enhance spatial understanding and pre-procedural planning, while computational modelling and three-dimensional (3D) printing enable patient-specific haemodynamic simulation and procedural rehearsal.”

“Current evidence, though modest and largely single-centre, consistently shows that 3D models can faithfully represent complex anatomy and that clinicians repeatedly report improved comprehension of spatial relationships through their use.”

“Overall, the use of 3D imaging has resulted in a better understanding of anatomy, with a direct impact on the surgical and catheter approach, particularly in more complex cases.”

“Rigorous pre-procedural planning with 3D modelling was crucial to overcome the technical and diagnostic challenges in this complex congenital heart disease.”

“This case highlights the utility of VR-based planning in optimizing surgical strategy for complex congenital heart defects.”

“We report how the use of a 3-dimensional virtual reality model informed an accurate estimation of a 34-month-old child's ventricular chamber size to confirm Fontan completion.”

“We report the successful transapical device closure of a large left ventricular pseudoaneurysm following a Ross procedure for aortic valve IE.”

“Preoperative MixR allowed a comprehensive understanding of complex anatomical relationships and spatial mapping, using immersive 3-dimensional navigation.”

“This planning aided the surgical team preparation for the challenge of a complex transplant surgery.”

“The CT-based VR model (Vmersive, VR-learning, Poland; Figure 1 D ) allowed precise spatial planning of the catheterization, including access from the SVC.”

“The patient underwent successful biventricular repair via the Rastelli procedure and AVSD repair.”

“Procedural success rate was 100%.”

100%

“Virtual reality imaging aided visualisation, decision-making, and planning.”

“The angulations and take-off of the lobar branches bearing the AVMs could be understood, and catheter approaches were planned.”

“The feasibility of procedural planning in a virtual arena has proved helpful in our institution in a variety of different interventions.”

“They helped the surgeon completely manage the details of the surgery.”

“From 2018 to 2020 there were 112 individual 3D modeling cases performed, 16 for educational purposes and 96 clinically utilized for procedural planning.”

“The implementation showed it is intuitive to plan and verify the procedure using VR.”

“Evaluating performance, we found that visualisation of the mesh and streamlines was at an acceptably high and stable frame rate, over 150fps.”

“The use of these three new technologies had favourable feedback from the surgeons on intraoperative judgment.”

“Baffles could be rapidly created and revised to facilitate planning of the surgical procedure.”

“The median post-processing time to get VR models using DIVA was 5 min in comparison to 8 h (range 8-12 h including printing time) for 3D models (PDF/printed).”

5 min

“The available features were evaluated by imaging and nonimaging clinicians, showing that the virtual reality system can help improve the understanding and communication of three-dimensional echocardiography imaging and potentially benefit congenital heart disease treatment.”

“Viewing the models in virtual reality allowed the team to precisely locate the defects and decide on a hybrid transcatheter and surgical approach to ensure successful repair.”

“Learning to use the system was perceived as easy for all but one participant, who rated it as ‘Somewhat difficult’.”

“The results show a marginal improvement of measurement accuracy with haptic feedback, compared to no haptics (see Figure a).”

“This tool allowed us to inspect the intracardiac anatomy in an immersive environment with a clearer sense of perspective.”

“In addition to the clinical assessment of the computed tomography and the integration of 3D reconstructions into the electroanatomical mapping system, 3D printing and virtual reality assessment showed its value in preprocedural planning of the intervention.”

“The use of VR for cardiac presurgical planning is feasible using existing imaging data.”