Extended reality for procedural planning and guidance in structural heart disease – a review of the state-of-the-art

Abstract

Extended reality (XR), which encompasses virtual, augmented and mixed reality, is an emerging medical imaging display platform which enables intuitive and immersive interaction in a three-dimensional space. This technology holds the potential to enhance understanding of complex spatial relationships when planning and guiding cardiac procedures in congenital and structural heart disease moving beyond conventional 2D and 3D image displays. A systematic review of the literature demonstrates a rapid increase in publications describing adoption of this technology. At least 33 XR systems have been described, with many demonstrating proof of concept, but with no specific mention of regulatory approval including some prospective studies. Validation remains limited, and true clinical benefit difficult to measure. This review describes and critically appraises the range of XR technologies and its applications for procedural planning and guidance in structural heart disease while discussing the challenges that need to be overcome in future studies to achieve safe and effective clinical adoption.

Cardiovascular Computed Tomography in the Diagnosis of Cardiovascular Disease: Beyond Lumen Assessment

“…Rapid developments in 3D innovative technologies, including VR, AR, and MR, have further advanced the roles of traditional image visualizations in cardiovascular disease and patient care, with increasing studies proving their educational and clinical value in cardiovascular medicine. Due to complex cardiovascular anatomical and pathological aspects and the importance of lifelong learning and training required to deliver highquality standards in cardiovascular care, these 3D visualizations serve as useful tools for healthcare providers and patients [64][65][66][67][68]105,[173][174][175][176][177][178][179][180][181][182].…”

“…In the context of cardiovascular disease, the applications of VR and AR mainly lie in the field of interventional cardiology for the purposes of procedural simulation and training, such as planning or simulating TAVR, CHD, or valvular interventions; left atrial appendage occlusion; and/or cardiac ablation procedures [105,[174][175][176][177][178][179][180][181][182]. Studies have shown that the use of VR-/AR-guided approaches can result in more successful attempts with fewer distance errors, shorter navigation times, and shorter path lengths during valvular interventional procedures [65,105]. These techniques are showing great potential for integration into cardiac catheterization laboratories, although more robust studies including more patients are needed.…”

“…CT-derived post-processing approaches have transformed the clinical value of cardiovascular CT in cardiovascular disease, and this transformation has led to the creation of patient-specific physical models such as 3D-printed personalized heart and vascular models [49][50][51][52][53][54][55][56][57][58][59][60][61][62][63] and virtual models for visualization, created using virtual reality (VR), augmented reality (AR), and mixed reality (MR) [64][65][66][67][68]. These innovative 3D visualization tools augment the current applications of cardiovascular CT to go beyond the traditional diagnostic approach, as these novel tools can be used for educational purposes, medical training, and the simulation of cardiac procedures, as well as to enhance doctor-patient communication [49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64][65][66][67][68]. Further, with the increasing use of artificial intelligence (AI) in medicine, the role of cardiovascular CT has also been enhanced with machine learning (ML) and deep learning (DL) algorithms being incorporated into standard practices to improve the workflow of current practices, in addition to increasing diagnostic accuracy and the predict...…”

How Will Artificial Intelligence Shape the Future of Decision-Making in Congenital Heart Disease?

“…VR immerses surgeons in realistic surgical scenarios using interactive virtual 3D environments [72][73][74]. Conversely, the AR system overlays virtual information in a real-world environment by transposing anatomical structures, surgical plans and intraoperative guidance into the surgeon's field of view [42,75]. Cattapan et al performed an observational study involving cardiac surgery residents to assay the role of surgical simulation on 3D cardiac models as a promising innovative tool to improve understanding of cardiac anatomy, facilitate hands-on learning and enhance proficiency in surgical techniques and confidence levels when performing cardiac surgery [76].…”

Enhanced and Combined Representations in Extended Reality through Creative Industries

“…In recent years, the development of immersive technologies has been remarkable [32,33]. Their adoption, across a wide spectrum of socio-economic life, is expected to increase steadily, especially as we enter the age of virtual worlds and metaverses [34][35][36][37][38][39]. Extended reality (XR) is characterized by augmented reality (AR), virtual reality (VR), and mixed reality (MR).…”