MO62. Holographic Imaging/Mixed Reality in Degenerative Mitral Disease: a New Tool for a Better Understanding and Planning Operations in Complex Multi-scallops Prolapse?
Cardioteam Foundation San Gaudenzio Clinic
Novara
Italy - Contact Me
Graduated Magna cun Laude at Turin University in November 1985 with a study on Heart Transplantation. Became the youngest Chief Cardiac Surgeon in Italy in 1995 at the age of 35 in a new center in Torino performing 1200 cardiac surgical procedures per year creating the 'Cardioteam' a group of Cardiac surgeons, cardiologists and cardioanestesiologists. The purpose was to put the patient at the center of the terapeutic terapies chosen as team . He performed more than 14.000 cardic procedures including minimally invasive aortic surgery, endoscopic mitral repair, totally arterial myocardial revascularization, aortic sparing procediures: David operation aand aortic valve repair. In 1998 he performed the first videassisted arterial bypass operation through a small minithoracotomy and in 2001 one of the first robotic operation and robotic training for urologists and general surgeons. In 2008 became President of The Cardioteam Foundation, onlus dedicated to prevention, training on cardiovascular terapies on International basis in Romania, Poland, Moldova. From September 2019 he is Chief of Minimally Invasive and Endoscopic Cardiac Surgery Dpt in IRCCS Policlinico San Donato. Milan. Italy.
Description
Methods: Preliminarily we evaluated the feasibility of assessing the pre-operative MV anatomy of patients using HIMR technology starting from a 256 slices CT scan. Patients undergoing MV surgery with multi-segment prolapse underwent a dynamic ECG-gated contrast enhanced CT scan. Acquired clinical images were used as an input for a new created software building a 3D patient-specific holographic reconstructions in 34 cases. Than 10 cardiac surgeons from our staff were asked to compare the HIMR imaging with the corresponding 3D intraoperative TOE by a questionnaire.
Results: The dynamic HIMR was successful reconstructed in 94% of the cases from complex degenerative mitral valve CT scan. In a subjective non quantitive evaluation all the surgeons (n 10) have confirmed a better visualization of the prolapsing scallops in HIMR mode with higher anatomical spatial definition in systole and diastole. From an objective point of view all surgeons could explored the surrounding structure : the subvalvular apparatus ( papillary muscles), the LV outflow tract and Cx artery in a real 3D mode, from different planes and perspectives ( not possible with TOE).
Conclusion: This software provided an intuitive way to fully appreciate the complex MV morphology and dynamics. Objective advantages of HIMR compared to TOE is the enhanced visualization of the valve and surrounding structures in a real 3D mode. Surgeons have the possibility to navigate into the true anatomy through a direct interaction by dynamic holograms providing a real perception of depth and spatial relationships. HIMR has the disadvantage not to be a real time technology but it is a promising new tool for surgeons and cardiologists in undertstanding and planning repair on complex mitral valve cases. Further studies are necessary to prove the real clinical advantage of this new exciting technology.