Impact Of Virtual Reality Simulation For Precise Geometric Mitral Valve Repair
KAZUTOSHI TACHIBANA, MD.,PhD, TAKAKIMI MIZUNO, MD., MASATO YONEMORI, MD..
Hakodate Goryoukaku Hospital, Hakodate, Japan.
BACKGROUND: Advancing of the virtual reality (VR) technologies have enabled useful therapeutic guiding in clinical practice. However, it has been controversial how to use VR system in cardiac surgery. Mitral valve repair is one of the standard surgical treatments for mitral regurgitation. To improve long term outcome of mitral valve repair, accurate geometric reconstruction is necessary. We describe the novel simulation system for precise geometric reconstruction of mitral valve prolapse.METHODS: Preoperative stereolithographic files in total 28 mitral valve complex of mitral valve prolapse were converted by using 320-slice computed tomography. The preoperative VR simulation can provide intuitive examination of the mitral valve under more physiologic conditions (Systolic & Strain) than intraoperative cardiac arrest (Diastolic & Flaccid). This strategy of mitral valve repair is to achieve accurate artificial chordae height and position between prolapse leaflet and tip of papillary muscle by using VR simulation. The aim of this study was to clarify the efficacy of VR simulation for precise geometric mitral valve reconstruction. RESULTS: There are three main points in using VR simulation system. At first, the length and width of prolapsed leaflet were identified intuitively and measured accurately. Secondly, the anatomical form of papillary muscles was confirmed via surgical view. The target of papillary muscle was obtained actuality. Finally, the simulation of artificial chordae height was achieved in perspective. We can confirm the accurate length and direction of each artificial chordae through the 3-dimentional VR glasses. The mean height and width of prolapse leaflets were 7.7±1.2 mm and 22.9±3.2mm. The mean predicted length of artificial chordae was 18.3±5.4 mm. The early mortality and morbidity were 0%. The residual regurgitations were not detected in all cases completely. All patients did not need any transfusions. The most of these patients were extubated in operation room immediately. CONCLUSIONS: VR simulation could further improve the advantage of mitral valve repair more simply and precisely. 
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