Being able to “transport the user inside the human body” before surgery translates into better planning for the procedure, wrote a group led by Dr. Xavier Ruyra of the Quironsalud Teknon Heart Institute in Barcelona. The researchers’ work was published Oct. 18 in Interactive Cardiovascular and Thoracic Surgery.
“In almost half of the cases [in our study] consideration of new information provided by the virtual reality models led the team to redesign the procedure plan,” he noted. “In all procedures, this additional information increased the confidence of the [surgical team] during implantation.
TAVR is a procedure used to mitigate aortic valve stenosis and is performed by interventional radiologists and cardiac surgeons. Patients referred for TAVR are usually imaged before the procedure with multidetector CT; This data is then put through a 3D reconstruction process to visualize the aortic valve access path and the “landing zone” for the artificial valve to be implanted using particular software (such as that developed by the Dutch firm 3mensio Medical Imaging).
The images can then be viewed with a VR headset that displays a computer-generated “environment” that gives surgeons an “unlimited view of the anatomy from all angles in an immersive experience with high fidelity and precision,” the team explained. .
“In recent years there has been [has been] There is growing interest in 3D printing models to improve outcomes of complex cardiovascular cases, including TAVR procedures…but interaction with the model is limited,” the authors wrote. “Virtual reality enables [us] step forward and cross the barrier into a different universe where [can] interact with the anatomy.
Ruyra and colleagues conducted a study that included 11 patients with severe aortic valve disease recommended for TAVR between May 2020 and May 2021. All underwent CT to acquire images of their heart anatomy and determine the access route and valve landing area. Using the CT data collected for each patient, the team built a virtual platform using VisuaMed software from the Spanish firm Techer Team that incorporated the patients’ clinical information and a virtual model of their anatomy.
Each patient served as their own control, being evaluated first using imaging techniques such as echocardiography, angiography, and multidetector computed tomography, and then again with the virtual reality models created by Ruyra and colleagues. Routine imaging data for all 11 cases was successfully converted to the virtual reality model, the group noted.
All patients passed the procedure without major complications, although two presented mild paravalvular leaks. The median hospital stay was about four days, including an average of 18 hours in the intensive care unit.
VR information modified the surgeons’ implant strategy in 45.4% of cases. Ruyra and his colleagues described some specific cases:
- In two cases, the VR model showed that the sinuses of Valsalva were wide enough for implantation and TAVR could be performed without the need for additional coronary protection.
- In another case, a 74-year-old woman with severe aortic stenosis and previous mitral valve replacement, virtual reality modeling showed that surgeons should move the implant higher up the valve to prevent future migration.
- One patient was initially referred for TAVR, but after surgeons reviewed the VR model data, he was referred for valve replacement surgery.
Although the study cohort was small, the findings are promising, according to the researchers.
“Our study suggests that in TAVR patients with complex scenarios, the immersive experience provided by virtual reality could contribute to achieving the best possible plan for each patient,” they concluded.
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