Virtual reality for pre-procedural planning of valve-in-valve transcatheter aortic valve implantation

Valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) has proven to be an effective treatment option for high-risk patients with degenerated surgical bioprosthetic aortic valves. Multislice computed tomography (MSCT) analysis, the current gold standard for procedural planning, has certain limitations. Virtual reality (VR) could optimize pre-procedural planning by delivering three-dimensional (3D) patient-specific information. This study aimed to investigate the feasibility of visualizing the bioprosthesis and adjacent structures with VR, as well as the accuracy and reproducibility of VR measurements and their advantages and limitations in planning ViV-TAVI.

The visualizations and measurements were performed using 3mensio software and VR software by analysts blinded to the results of the other software based on MSCT data from 20 patients who underwent ViV-TAVI interventions. Moreover, eight physicians graded numerous aspects of pre-procedural ViV-TAVI planning with and without VR visualizations. The analysis showed no significant differences between the measurements and strong correlations with correlation coefficients between 0.874 and 0.994, P < 0.001. Moreover, good-to-excellent intra- and interobserver reliability with intraclass correlation coefficient values between 0.897 and 0.986 was documented. The qualitative analysis showed that 3D visualization using VR facilitates assessing the spatial relationships between the structures. Furthermore, VR enabled a superior visual understanding of the bioprosthesis and the distances between the virtual prosthesis and the coronaries as well as the sinotubular junction.

Virtual reality can be a valuable addition to the pre-procedural planning of ViV-TAVI interventions, thanks to detailed 3D visualization and precise measurements. Further studies are needed to assess the impact on patient outcomes.