Utility of virtual reality imaging to guide complex structural cardiac interventions: A randomized controlled trial

Accurate preprocedural planning is critical for complex transcatheter structural heart interventions. Virtual reality (VR) enhanced imaging may improve accuracy compared to conventional computed tomography (CT) and may reduce variability between operators of differing experience levels.

A randomized study evaluated the utility of VR across three complex interventions: sinus venosus defect (SVD) closure, pulmonary artery (PA) stenting, and percutaneous pulmonary valve implantation (PPVI). The preprocedural planning was randomized to either CT alone or CT plus VR. Independent planning based solely on CT, performed by a senior cardiologist (experience >25 years) and a junior cardiologist (experience > 5 years), was compared with CT plus VR analysis performed by the junior cardiologist. Deviation in plan during the actual intervention was analyzed.

Forty patients (20 SVD closure, 12 PA stents, and 8 PPVI) were randomized to receive either CT alone or CT plus VR. Comparable demographics confirmed effective randomization. The Friedman test revealed a significant overall difference (P = 0.0195) in deviation from the preprocedural plan between the groups. CT by a junior cardiologist showed a significantly greater deviation than that by the senior cardiologist (P = 0.0098). Adding VR reduced plan deviations and was comparable to those of the senior cardiologist (P = 0.233), indicating enhanced understanding by an early-career operator. For the SVD subset, VR showed significantly better agreement with the procedural outcome than the senior cardiologist (P = 0.0196). No significant differences in planning accuracy were observed between the methods in PPVI or PA stenting. Despite VR's potential to simplify the intervention, it did not affect procedural duration or contrast volume in this early experience.

The VR interpretation by a junior cardiologist matched the senior cardiologist's plan based on CT alone and outperformed the junior cardiologist's plan when using CT alone. This indicates the potential of VR to accelerate training in structural interventions and standardize preprocedural planning.