Indian Journal of Thoracic and Cardiovascular Surgery | 2021
Virtual reality: a useful simulation tool for planning and training
Abstract
Subsets of patients with end-stage heart failure or low cardiac output can be catered with left ventricular assist device (LVAD) either as a bridge to transplant or destination therapy. In patients with severe pulmonary artery hypertension (PAH), it can also function as a bridge to decision-making. The pediatric population is underserved in the assist device market with very few commercially available assist devices designed especially for the pediatric population. Young children have been served by devices primarily made for adults. In children with restrictive cardiomyopathy, the ventricular size is small and it is difficult to predict with confidence if the inflow cannula designed for adults would sit and align correctly. The usually available tools of echocardiography, computed tomography (CT) angiography, and cardiac catheterization can give some idea, but to get it right the first time with confidence needs a more advanced presurgical planning tool, and virtual reality can help us precisely do this with no significant increase in the total expenditure. Situations like this have a very low safety net and it is important to get it right the first time [1]. A recent study by Davies et al. has employed virtual reality simulated implantation to appraise successful intrapericardial placement of the HeartWare ventricular assist device (HVAD) and the HeartMate3 intrapericardial pumps in children. They documented more precise judgment of pump position within the chest during implantation which could be possible because of the virtual reality tool in their study [2]. Similarly, Sadeghi and colleagues reviewed anatomy and preoperative planning of minimally invasive direct coronary artery bypass in an 18-year-old male patient with Kawasaki disease and affiliated left anterior descending (LAD) and right coronary artery (RCA) aneurysms by depicting a CT scan in an immersive virtual reality (VR) surroundings [3]. Moreover, Ferng et al. described the utility of virtual implantation of total artificial heart in smaller adult patient [4]. The idea behind the procedure is that intrathoracic and intacavitatory positioning of the LVAD was analyzed preoperatively and the clinical outcome could be correlated precisely. It will allow tailored surgical approach according to individual patient’s anatomy using advanced technology. Virtual reality is expected in perspective to facilitate patientspecific preoperative simulation of optimal left ventricular coring site and LVAD implantation with the aid of computer-assisted surgery techniques. We suggest that virtual reality could be an important contribution to pediatric cardiac surgery including congenital cardiac surgery or implantation of LVAD, HVAD, or total artificial heart, and should be an important tool in the armamentarium of surgeons. This is a useful technology in smaller built patients and helps in providing a precise and tailored surgical approach especially in the absence of a safety net. We envisage this technology will have a role in anatomy tailored surgical approach in minimally invasive cardiac surgery and in the repair of complex congenital heart defects in addition to device implantations in the young. More studies are necessitated to standardize this tool. It is not difficult to imagine the immense potential virtual reality has, as not only planning but also a training and educating tool. Virtual anatomical dissections are possible reducing the dependence on cadaveric dissections [5] With this tool, a trainee or a surgeon can precisely carry out the steps before the actual surgery, in the presence of team members including the nursing and perfusion-staff, increasing the efficiency and safety of any complex procedure. There is increased scope of remote collaborations, serving the underserved areas, democratizing the availability of cardiovascular surgical skills, and making remote mentorship possible. * Dhruva Sharma [email protected]