Planning of transcatheter aortic valve implantation using computed tomography and virtual reality - a prospective, randomized controlled trial

Abstract Background Successful transcatheter aortic valve implantation (TAVI) requires precise preprocedural planning and is essential for patient safety and valve longevity. Three-dimensional (3D) imaging plays a crucial role in this. Virtual reality (VR) can optimize the planning of interventions through the detailed visualization of cardiac, extracardiac and vascular structures. Purpose The study investigated whether the inclusion of VR in preprocedural planning, which is currently performed using multi-slice computed tomography (MSCT), can improve the understanding of individual patient anatomy and optimize the performance of interventions. Methods This randomized, prospective, controlled study included 140 patients who underwent TAVI or valve-in-valve TAVI at our hospital. In the control arm, preprocedural visualizations and measurements were performed based on MSCT data using the 3mensio software (3mensio Structural HeartTM, Pie Medical Imaging BV, Maastricht, Netherlands). In the intervention group, planning was performed additively using VR software (Medicalholodeck, Zurich, Switzerland). In addition, the interventionalists used a structured questionnaire to evaluate numerous aspects of preprocedural TAVI planning with 3mensio and the VR software. Results The evaluation did not reveal any relevant differences in patient characteristics. In terms of visualization of anatomy, understanding of 3D relationships between structures, and assessment of access routes, VR was superior to 3mensio software, especially in terms of depth perception, visualization of atherosclerotic plaques at access sites, and iliofemoral tortuosity (237 individual assessments by cardiologists and cardiac surgeons). Both methods were found to be useful and helpful in preparing for the procedure. There were no significant differences in procedural data between the two groups. However, the VR group had a lower rate of bleeding at the access site (p0.05). There was no significant difference in the length of hospital stay and post-procedural transthoracic echocardiography data evaluations. Conclusion The data show that virtual reality visualization can optimize preparation for the procedure by improving the 3D understanding of the aortic valve and adjacent structures. The detailed visualization of the access routes can lead to a reduction in periprocedural complications.