Pre-procedural planning of transcatheter mitral valve replacement in mitral stenosis with multi-detector tomography-derived 3D modeling and printing: a case report

Computer-Assisted Transcatheter Mitral Valve Implantation for Valve-in-Valve Procedures

Transcatheter mitral valve-in-valve is an alternative to high-risk reoperation on a failing bioprosthesis. It entails specific challenges such as left ventricular outflow tract obstruction. We propose a patient-specific augmented imaging based on preoperative planning to assist the procedure. Valve-in-valve simulation was performed to represent the optimal level of implantation and the neo-left ventricular outflow tract. These data were combined with intraoperative images through a real-time 3D/2D registration tool. All data were collected retrospectively on one case (pre and per-procedure imaging). We present for the first time an intraoperative guidance tool in transcatheter mitral valve-in-valve procedure.

Mitral Valve-in-Valve Implant of a Balloon-Expandable Valve Guided by 3-Dimensional Printing

Background

Our goal was to explore the role of 3-dimensional (3D) printing in facilitating the outcome of a mitral valve-in-valve (V-in-V) implant of a balloon-expandable valve.

Methods

From November 2020 to April 2021, 6 patients with degenerated mitral valves were treated by a transcatheter mitral V-in-V implant of a balloon-expandable valve. 3D printed mitral valve pre- and post-procedure models were prepared to facilitate the process by making individualized plans and evaluating the outcomes.

Results

Each of the 6 patients was successfully implanted with a balloon-expandable valve. From post-procedural images and the 3D printed models, we could clearly observe the valve at the ideal position, with the proper shape and no regurgitation. 3D printed mitral valve models contributed to precise decisions, the avoidance of complications, and the valuation of outcomes.

Conclusions

3D printing plays an important role in guiding the transcatheter mitral V-in-V implant of a balloon-expandable valve.

Clinical Trial Registration

ClinicalTrials.gov Protocol Registration System (NCT02917980).

The digital heart-lung unit: applications of exponential technology

Exponential technologies such as virtual reality (VR), computational modelling, and additive manufacturing have emerged in the field of cardiology and cardiothoracic surgery. An increasing number of publications that evaluate the clinical role of these technologies are becoming available. Moreover, there is an increase in the number of hospitals and departments that have implemented digital and exponential solutions in clinical workflow. In our centre, we have adopted various exponential technologies in order to improve clinical pre-procedural workflow, patient care, and training and education. In order to provide our view and approach on the implementation of these technologies, in this article, we provide an overview of the currently applied modalities including immersive VR, three-dimensional (3D) computational modelling, VR-based simulations, and additive manufacturing (3D printing). Moreover, we present the potential of these applications in cardiovascular and cardiothoracic medicine, and additionally, we will provide key facilitators, challenges, and recommendations to adopting these technologies in clinical practice.

Immersive 3D virtual reality imaging in planning minimally invasive and complex adult cardiac surgery

Aims

Increased complexity in cardiac surgery over the last decades necessitates more precise preoperative planning to minimize operating time, to limit the risk of complications during surgery and to aim for the best possible patient outcome. Novel, more realistic, and more immersive techniques, such as three-dimensional (3D) virtual reality (VR) could potentially contribute to the preoperative planning phase. This study shows our initial experience on the implementation of immersive VR technology as a complementary research-based imaging tool for preoperative planning in cardiothoracic surgery. In addition, essentials to set up and implement a VR platform are described.

Methods

Six patients who underwent cardiac surgery at the Erasmus Medical Center, Rotterdam, The Netherlands, between March 2020 and August 2020, were included, based on request by the surgeon and availability of computed tomography images. After 3D VR rendering and 3D segmentation of specific structures, the reconstruction was analysed via a head mount display. All participating surgeons (n = 5) filled out a questionnaire to evaluate the use of VR as preoperative planning tool for surgery.

Conclusion

Our study demonstrates that immersive 3D VR visualization of anatomy might be beneficial as a supplementary preoperative planning tool for cardiothoracic surgery, and further research on this topic may be considered to implement this innovative tool in daily clinical practice.

Lay summary

Over the past decades, surgery on the heart and vessels is becoming more and more complex, necessitating more precise and accurate preoperative planning. Nowadays, operative planning is feasible on flat, two-dimensional computer screens, however, requiring a lot of spatial and three-dimensional (3D) thinking of the surgeon. Since immersive 3D virtual reality (VR) is an upcoming imaging technique with promising results in other fields of surgery, we aimed in this study to explore the additional value of this technique in heart surgery. Our surgeons planned six different heart operations by visualizing computed tomography scans with a dedicated VR headset, enabling them to visualize the patient's anatomy in an immersive and 3D environment. The outcomes of this preliminary study are positive, with a much more reality-like simulation for the surgeon. In such, VR could potentially be beneficial as a preoperative planning tool for complex heart surgery.