Why the study?
Accurate preprocedural planning is critical for complex transcatheter structural heart interventions, and VR-enhanced imaging may improve accuracy and reduce variability between operators of differing experience levels.
Does preprocedural planning with CT plus virtual reality improve procedural outcomes and reduce planning deviations compared to CT alone in patients undergoing complex structural cardiac interventions?
RCT (n=40)
Block randomization technique, stratified based on the three interventions
No
Does preprocedural planning with CT plus virtual reality improve procedural outcomes and reduce planning deviations compared to CT alone in patients undergoing complex structural cardiac interventions?
Answers are grounded in this paper and cite their sources.
Virtual reality-enhanced imaging standardizes preprocedural planning in complex structural interventions, empowering early-career cardiologists to achieve planning accuracy comparable to highly experienced operators using CT alone.
Background: 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. Methods: 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. Results: 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. Conclusions: 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.
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Garg et al. (2025) conducted an RCT in Complex structural congenital heart disease requiring transcatheter intervention (n=40). Preprocedural planning using CT plus Virtual Reality (VR) vs. Preprocedural planning using CT alone was evaluated on Procedural success (component of primary composite outcome) (p=0.335).
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