Virtual reality in planning complex heart surgery

Area of Science:

• Cardiovascular Surgery
• Medical Imaging
• Biomedical Engineering

Background:

• Intraventricular tunneling (IVT) is crucial for biventricular (2V) or one-and-a-half ventricle (1.5V) repair of complex congenital heart defects (CCHD).
• Traditionally, IVT relies on surgeon's intraoperative judgment, which can be challenging in complex cases.

Purpose of the Study:

• To evaluate novel assistive tools, specifically 3D Virtual Reality (3DVR) and 3D printing (3DP) technologies, for aiding IVT during complex CCHD surgical repairs.
• To assess the feasibility and efficacy of using virtual planning and 3D printed templates for baffle design and placement.

Main Methods:

• CT data from CCHD patients were converted into 'digital twins' for analysis in 3DVR using medical modeling software.
• Virtual dissection, annotation, and measurement tools were employed to identify critical anatomical elements and plan the optimal IVT pathway.
• Virtual baffle designs were translated into physical templates using 3DP (flexible and rigid resins) and paper printing for use as surgical guides.

Main Results:

• Twenty CCHD cases with diverse anatomical variations underwent repair using the 3DVR and 3DP workflow, achieving 100% repair success (12 2V, 8 1.5V).
• Virtual, 3D printed, and paper templates showed identical morphometrics and were successfully used as surgical guides with <10% deviation from predicted geometry.
• All repairs were completed with single-patch baffles placed per digital plan, resulting in no residual defects, no operative mortality, and a median hospital stay of 10 days.

Conclusions:

• Early exploration of 3DVR-based baffle planning demonstrates encouraging translational impact in CCHD surgery.
• The workflow for creating 'paper printable' baffle templates shows significant promise for improving IVT procedures.