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      Virtual reality-guided aortic valve leaflet reconstruction for type 0 bicuspid aortic stenosis

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          Abstract

          Although virtual reality (VR) techniques that enable visualizing a patient’s anatomy stereoscopically have been developed recently, these techniques are still scarcely used in clinical settings, and their benefits remain uncertain. Herein, we demonstrate how VR preoperative planning facilitated the efficiency of a complex surgical procedure. A 53-year-old male was diagnosed as type 0 bicuspid aortic stenosis. To take haemodynamical advantage and to lower valve-related reoperation risks, an aortic valve reconstruction was scheduled; however, anatomical tri-leaflet neocuspidalization for type 0 bicuspid aortic root is particularly challenging. To optimize the procedure, VR preoperative planning was applied to create a blueprint of the aortic root rearrangement and suture line design. This allowed for a competent aortic valve to be reconstructed speedily, resulting in an excellent postoperative course.

          Abstract

          A 53-year-old male was admitted to our hospital and diagnosed as type 0 bicuspid aortic valve with symptomatic aortic stenosis (Fig. 1A) and an aortic valve reconstruction was scheduled.

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          Augmented and virtual reality in surgery-the digital surgical environment: applications, limitations and legal pitfalls.

          Wee Sim Khor, Benjamin Baker, Kavit Amin … (2016)
          The continuing enhancement of the surgical environment in the digital age has led to a number of innovations being highlighted as potential disruptive technologies in the surgical workplace. Augmented reality (AR) and virtual reality (VR) are rapidly becoming increasingly available, accessible and importantly affordable, hence their application into healthcare to enhance the medical use of data is certain. Whether it relates to anatomy, intraoperative surgery, or post-operative rehabilitation, applications are already being investigated for their role in the surgeons armamentarium. Here we provide an introduction to the technology and the potential areas of development in the surgical arena.
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            Aortic valve replacement through a minimally invasive approach: preoperative planning, surgical technique, and outcome.

            André Plass, Hans Scheffel, Hatem Alkadhi … (2009)
            This study reports the experiences of minimally invasive aortic valve replacement (MIAVR) through a right minithoracotomy performed in the past 26 months and describes the surgical technique, the learning curve, the complication rate, and the patient outcomes. From March 2006 to June 2008, 172 patients (113 men; mean age, 71 +/- 12 years) were scheduled for MIAVR (6- to 7-cm incision). Multislice computed tomography (MSCT) imaging was used for surgical planning in 139. Aortic cannulation/clamping were performed through a right-sided minithoracotomy and venous cannulation percutaneously through the groin. For obtaining optimal intercostal space (ICS) distances between the incision to the aorta and cardiac structures, 2- and 3-dimensional MSCT images were evaluated. Operations were done in 171 patients. MIAVR was successfully performed in 160 (94%). Six patients underwent a conventional operation due to adhesions in 4, small diameter of aortic annulus (17 mm) in 1, and concomitant coronary artery disease in 1. One patient was considered nonoperable. After CT-planning choice of second ICS in 17%, third in 81%, and fourth in 1%. Five conversions to sternotomy were necessary. Intraoperative and postoperative complications occurred in 20 patients, including 1 death. Overall cardiopulmonary bypass was 158 +/- 41 min and cross-clamp time was 107 +/- 26 min. No blood products in 43% of MIAVR patients. Mean hospital length of stay was 10 +/- 3 days. MIAVR demonstrates excellent results. A considerably reduced complication rate in the course was noted. MSCT for preoperative planning is helpful for an improved mental preparation and for an accurate surgical strategy, including optimal access.
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              Aortic valve reconstruction with use of pericardial leaflets in adults with bicuspid aortic valve disease: early and midterm outcomes.

              Hyun Chee, Je Shin, Jong Bum Choi … (2014)
              In this study, we retrospectively analyzed the outcomes of adults with bicuspid aortic valve (BAV) disease who underwent aortic valve reconstructive surgery (AVRS), consisting of replacement of the diseased BAV with 2 or 3 pericardial leaflets plus fixation of the sinotubular junction for accurate and constant leaflet coaptation. From December 2007 through April 2013, 135 consecutive patients (mean age, 49.2 ± 13.1 yr; 73.3% men) with symptomatic BAV disease underwent AVRS. Raphe was observed in 84 patients (62.2%), and the remaining 51 patients had pure BAV without raphe. A total of 122 patients (90.4%) underwent 3-leaflet reconstruction, and 13 (9.6%) underwent 2-leaflet reconstruction. Concomitant aortic wrapping with an artificial graft was performed in 63 patients (46.7%). There were no in-hospital deaths and 2 late deaths (1.5%); 6 patients (4.4%) needed valve-related reoperation. The 5-year cumulative survival rate was 98% ± 1.5%, and freedom from valve-related reoperation at 5 years was 92.7% ± 3.6%. In the last available echocardiograms, aortic regurgitation was absent or trivial in 116 patients (85.9%), mild in 16 (11.9%), moderate in 2 (1.5%), and severe in one (0.7%). The mean aortic valve gradient was 10.2 ± 4.5 mmHg, and the mean aortic valve orifice area index was 1.3 ± 0.3 cm(2)/m(2). The 3-leaflet technique resulted in lower valve gradients and greater valve areas than did the 2-leaflet technique. Thus, in patients with BAV, AVRS yielded satisfactory early and midterm results with low mortality rates and low reoperation risk after the initial procedure.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Interact Cardiovasc Thorac Surg
                Journal ID (iso-abbrev): Interact Cardiovasc Thorac Surg
                Journal ID (publisher-id): icvts
                Title: Interactive Cardiovascular and Thoracic Surgery
                Publisher: Oxford University Press
                ISSN (Print): 1569-9293
                ISSN (Electronic): 1569-9285
                Publication date Collection: June 2022
                Publication date (Electronic): 29 December 2021
                Publication date PMC-release: 29 December 2021
                Volume: 34
                Issue: 6
                Pages: 1152-1154
                Affiliations
                [1 ]Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine , Kobe, Japan
                [2 ]Department of Cardiovascular Surgery, Ageo Central General Hospital , Saitama, Japan
                Author notes
                Corresponding author. Department of Cardiovascular Surgery, Ageo Central General Hospital, 1-10-10 Kashiwaza, Ageo, Saitama 3628588, Japan. Tel: +81-48-773-1111; e-mail: t.tedoriya@ 123456cocoracompany.com (T. Tedoriya).
                Author information
                https://orcid.org/0000-0002-0988-8654
                https://orcid.org/0000-0001-9629-7803
                Article
                Publisher ID: ivab353
                DOI: 10.1093/icvts/ivab353
                PMC ID: 9214572
                PubMed ID: 34964048
                SO-VID: 3e6c7770-06f4-4d1a-8308-183ff17a69b9
                Copyright © © The Author(s) 2021. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 21 July 2021
                Date revision received : 08 October 2021
                Date accepted : 23 November 2021
                Page count
                Pages: 3
                Categories
                Subject: Case Reports
                Subject: Adult Cardiac
                Subject: AcademicSubjects/MED00920

                Keywords: virtual reality,preoperative planning,aortic valve reconstruction,aortic root anatomy
                Data availability:
                Keywords: virtual reality, preoperative planning, aortic valve reconstruction, aortic root anatomy

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