Immersive 3D Virtual Reality-Based Clip Sizing for Thoracoscopic Left Atrial Appendage Closure

Area of Science:

• Cardiology
• Medical Imaging
• Surgical Technology

Background:

• Surgical left atrial appendage (LAA) closure is a key stroke prevention strategy for patients with atrial fibrillation.
• Accurate LAA base sizing is crucial for effective clip placement and avoiding complications.
• Current imaging modalities may have limitations in precise LAA base measurement.

Purpose of the Study:

• To evaluate the feasibility and added value of immersive virtual reality (VR) for assessing LAA base size.
• To compare VR-based measurements with conventional computed tomography (CT) and intraoperative clip sizes.
• To determine if VR can improve the accuracy of clip selection for LAA closure.

Main Methods:

• Retrospective analysis of 15 patients who underwent thoracoscopic LAA clipping.
• Measurement of LAA base size using conventional 2D CT and immersive 3D VR.
• Comparison of imaging-derived measurements with the size of the placed epicardial clip.

Main Results:

• VR successfully measured LAA base size, with no significant difference compared to intracardial 3D VR or CT.
• VR measurements in surgeon's view were significantly larger than 2D CT and intracardial 3D VR.
• All imaging measurements significantly differed from placed clip sizes, suggesting potential intraoperative oversizing.

Conclusions:

• Immersive VR is a feasible tool for obtaining LAA base anatomical data.
• Discrepancies between imaging and intraoperative measurements indicate a risk of clip oversizing.
• 3D VR imaging may enhance preprocedural LAA base sizing accuracy, potentially preventing oversizing and improving outcomes.