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Augmented Reality Echocardiographic Navigation and Guidance for Beating Heart Transapical Mitral Valve Repair
Michael W. Chu1, John Moore1, Terry Peters1, Daniel Bainbridge1, Pencilla Lang1, Gerard Guiraudon1, Richard Daly2, Bob Kiaii1.
1University of Western Ontario, Robarts Research Institute, London, ON, Canada, 2Mayo Clinic, Rochester, MN, USA.
ISMICS 2012 Abstract Submission
Augmented Reality Echocardiography Navigation and Guidance for Beating Heart Transapical Mitral Valve Repair
Objective:
Emerging off-pump, beating heart valve repair techniques offer patients less invasive mitral valve repair alternatives. Neochord DS is a novel transapical tool that delivers PTFE neochords from the left ventricular apex to the mitral valve leaflets on the beating heart, relying upon conventional transesophageal echocardiography for tool navigation and guidance. However, echocardiographic guidance alone can be problematic as limited spatial and temporal resolution can make tool visualization challenging.
Methods:
Utilizing a magnetic tracking system and integrated sensors, we created a virtual reality environment displaying important intracardiac landmarks that is registered real-time to biplane TEE imaging. Two fixed views were constructed to assist with surgical navigation and guidance, including the apical ‘bulls-eye’ view to help navigate the tool from the apex to the mitral annulus and the mitral annular view to assist engaging the tool to the appropriate mitral valve leaflet. In a porcine model, we evaluated the efficacy of tool navigation from apex to the appropriate mitral leaflet with TEE guidance alone versus augmented reality navigation in 5 surgeons.
Results:
Magnetically tracked tool paths for TEE only and augmented reality navigation are displayed in Figure 1. TEE guidance alone resulted in multiple erroneous tool passes into the left ventricular outflow tract, aorta and undersurface of the anterior and posterior leaflets of the mitral valve. Augmented reality assistance greatly facilitated a more linear path through the mitral coaptation line without transgressing other structures. Mean time required for TEE guidance alone versus augmented reality guidance was 124±94 seconds versus 21±8 seconds, respectively.
Conclusions:
Augmented reality enhanced TEE greatly facilitates more direct and safe intracardiac navigation of the Neochord DS tool from left ventricular apex to mitral valve leaflet. Tracked too path results demonstrate improved safety and shorter operative times required.
Figure 1: 
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