Innovative Integration of 4D Cardiovascular Reconstruction and Hologram: Framework Development of a New Visualization Tool for Coronary Artery Bypass Grafting Planning

Abstract Background Planning for coronary artery bypass grafting (CABG) necessitates advanced spatial visualization skills and consideration of multiple factors, including the depth of coronary arteries within the subepicardium, calcification levels, and pericardial adhesions. Objective This study aimed to address these requirements by reconstructing a dynamic cardiovascular model, displaying it as a naked-eye hologram, and evaluating the clinical utility of this innovative visualization tool for preoperative CABG planning. Methods We used preoperative 4D cardiac computed tomography angiography (4D-CCTA) data from 14 patients scheduled for CABG to develop a semiautomated workflow. This workflow enabled time-resolved segmentation of the heart chambers, epicardial adipose tissue (EAT), and coronary arteries, complete with calcium scoring. Methods for segmenting cardiac structures, quantifying coronary calcification, visualizing coronary depth within EAT, and assessing pericardial adhesions via motion analysis were incorporated. These dynamic reconstructions captured spatial relationships, coronary stenosis, calcification, and depth in EAT, as well as pericardial adhesions. Dynamic cardiovascular holograms were then generated and displayed using the Looking Glass platform (Looking Glass Factory Inc). Thirteen cardiac surgeons assessed the utility of the holographic visualization tool on a Likert scale. In addition, a surgeon visually scored pericardial adhesions using the holograms of all 21 patients (including 7 undergoing secondary cardiac surgeries) and compared these scores with actual intraoperative findings. Results Cardiac surgeons highly rated the visualization tool for its utility in preoperative planning, with a mean Likert score of 4.57/5.0 (SD 0.5). The hologram-based scoring of pericardial adhesions showed a strong correlation with intraoperative findings (correlation coefficient r =0.786; P <.001). Conclusions This study delineates the structural framework of a visualization tool specifically designed for preoperative CABG planning. It produces high-quality, clinically relevant, dynamic holograms from patient-specific volumetric data, with clinical feedback confirming its practicality and effectiveness for preoperative surgical planning.