Mixed reality for preoperative planning and intraoperative assistance of surgical correction of complex congenital heart defects.

Abstract

Mixed reality (MixR) is an innovative visualization tool that presents virtual elements in a real-world environment, enabling real-time interaction between the user and the combined digital/physical reality. We aimed to explore the feasibility of MixR in enhancing preoperative planning and intraoperative guidance for the correction of various complex congenital heart defects. Patients underwent cardiac computed tomography or cardiac magnetic resonance imaging and segmentation of digital imaging and communications in medicine images was performed. Three-dimensional models were then uploaded into a MixR headset (Microsoft HoloLens 2), displayed as holograms, and used for preoperative navigation of cardiac anatomy and intraoperative assistance of surgical steps. We adopted MixR in 5 different clinical scenarios: minimally invasive partial anomalous pulmonary venous connection repair of 5 anomalous veins, intraextracardiac Fontan completion in right atrial isomerism and dextrocardia, arterial switch operation for transposition of the great arteries with abnormal coronary pattern in situs inversus, complete unifocalization of major aortopulmonary collateral arteries, and total artificial heart implantation for failing Fontan. Preoperative MixR allowed a comprehensive understanding of complex anatomical relationships and spatial mapping, using immersive 3-dimensional navigation. As a result, the surgeon was able to simulate the surgical approach and plan the best surgical strategy. Intraoperatively, MixR provided a real-time virtual map by overlaying holograms onto the patient's anatomy. MixR represents a promising tool for preoperative planning and 3-dimensional visualization in patients with complex congenital heart defects; however, its systematic adoption in intraoperative settings requires further implementation of current hardware technology and software versatility.