Patient-specific mixed reality for venus P-valve implantation: A novel approach to procedural planning

Background: Survival rates for patients with congenital heart disease (CHD) have improved, but complications like pulmonary regurgitation (PR) often require re-interventions. Transcatheter pulmonary valve implantation (TPVI) with self-expandable valves, such as the Venus P-Valve, has broadened treatment options. Accurate procedural planning, particularly valve sizing, remains a significant challenge. Mixed Reality (MxR) technology enables a patient-specific approach that enhances procedural planning accuracy. Aim: To evaluate the use of MxR in planning Venus-P valve implantation. Materials and methods: This study included patients undergoing Venus P-Valve implantation with holographic models generated from CT data using ARTICOR® software from January 2023 to June 2024. Two independent operators used these models for procedural planning. Concordance between operators was assessed. Predictions were compared with implanted valve dimensions to evaluate concordance. Results: Of 29 eligible patients, 26 underwent successful Venus-P valve implantation. Concordance between the operators reached 60 % (n = 15/26) for valve diameter and over 88 % (n = 23/26) for valve length. Holographic models achieved 96 % (n = 25/26) concordance in predicting valve length, type of the approach (92 %) and 50 % (n = 13/26) concordance for diameter. Discussion: Holographic models enhanced procedural planning, enabling better visualization and collaborative decision-making. While highly effective for valve length predictions, and type of the approach limitations in predicting valve diameter highlight the need for improved methods, such as computational modelling or machine learning. Conclusion: Patient-specific holographic models are promising tools for TPVI planning. Advancements in technology and interdisciplinary collaboration are critical to overcoming current limitations and advancing procedural planning and related outcomes in interventional cardiology. Condensed abstract: This study assesses the use of mixed reality (MxR) technology for procedural planning in transcatheter pulmonary valve implantation (TPVI) with the Venus P-Valve. Holographic models were created from CT data to aid in valve sizing and implantation strategies, with two operators comparing measurements for valve diameter and length. Among 26 patients who underwent successful implantation, concordance between operators was 60 % for valve diameter and 88 % for valve length. Predictions using holographic models showed 96 % concordance for implanted valve length, type of the approach (92 %) and 50 % concordance for valve diameter. These results highlight the potential of MxR for improving TPVI planning, though the limited accuracy for valve diameter suggests a need for further advancements, such as computational modeling or machine learning, to optimize procedural outcomes in interventional cardiology.