Patient Screening for Self-Expanding Percutaneous Pulmonary Valves using Virtual Reality

Background In recent years, self-expanding technology to treat pulmonary regurgitation in the native RVOT became FDA approved in the U.S. and is now routinely used. The current practice for selection of patients who are candidates for these devices includes screening for “anatomic fit”, performed by each of the manufacturing companies. Our study aims to validate the use of virtual reality as a tool for local physician-led screening of patients. Methods This retrospective study from Children’s Hospital Colorado included patients who underwent pulmonary valve replacement and had screening for a Harmony TPV or Alterra Pre Stent performed between September 2020 and January 2022. The data from the commercial companies dedicated analysis for self-expanding TPVR evaluation with perimeter analysis was collected. Virtual Reality simulation was performed blinded by two congenital interventional cardiologists using Elucis virtual reality software and an Oculus Quest 2 headset. Results Among the 27 evaluated cases, the use of a self-expandable valve was recommended by companies dedicated analysis in 23 cases (85.2%), by VR assessment in 26 cases (96.3) and finally implanted in 25 cases (92.6%). Regarding the level of agreement, both modalities (Manufacturer and VR) were good at screening in patients who received a self-expanding valve (100% vs. 96.1%). When it came to screening the patients out , VR presented good capacity to accurately classify non-suitable patients (50% vs. 100%). Conclusion Our institutional experience with virtual reality TPVR planning, accurately predicted clinical outcomes. This paves the way for routine use of VR in patient selection for self-expanding valve technologies.