Department of Cardiothoracic Surgery, Thoraxcenter, 6993Erasmus University Medical Center, Rotterdam, The Netherlands.
Innovations (Phila). 2022 Jul-Aug;17(4):304-309. doi: 10.1177/15569845221114344. Epub 2022 Aug 1.
Surgical left atrial appendage (LAA) closure using epicardial clips has become popular in stroke prevention in patients with atrial fibrillation. Optimal placement of the clip is essential to achieve complete LAA occlusion and to prevent complications due to compression of the circumflex artery. We determine the added value of immersive virtual reality (VR) in accurately assessing LAA base size and selection of an appropriately sized clip. We studied the feasibility of measuring the LAA base using VR and conventional computed tomography (CT). A retrospective analysis was performed of LAA base measurements in 15 patients who had undergone thoracoscopic LAA clipping. Subsequently, we compared the placed clip size with imaging-acquired LAA base size to retrospectively evaluate intraprocedural sizing. We successfully applied a VR platform to measure LAA base size. The median LAA base size measured in CT (23.8 mm, interquartile range [IQR] 22.3 to 26.4 mm) and intracardial virtual reality (23.4 mm, IQR 21.6 to 25.5 mm) did not differ significantly ( = 0.416). VR measurements of the LAA base in surgeon's view (25.7 mm, IQR 24.2 to 29.2) were significantly higher than those of 2-dimensional CT ( = 0.037) and intracardial 3-dimensional (3D) VR ( < 0.05) measurements. All measurements differed significantly with placed clip sizes ( < 0.05). There were no clip malpositioning-related events. Immersive VR is a feasible method for obtaining anatomical information on LAA base size. In this retrospective analysis, CT and VR-based measurements of LAA base size differed significantly from intraoperatively placed LAA clips, indicating potential oversizing when measured intraoperatively. Using intuitive 3D VR-based imaging might be a useful method to assist in accurate preprocedural sizing of LAA base and can potentially prevent oversizing.
经胸心外膜夹闭左心耳（LAA）在预防房颤患者的中风中变得越来越流行。为了实现完全的 LAA 闭塞并防止因回旋动脉受压而产生的并发症，夹闭的最佳位置是至关重要的。我们确定沉浸式虚拟现实（VR）在准确评估 LAA 基底大小和选择合适大小的夹闭器方面的附加值。我们研究了使用 VR 和传统计算机断层扫描（CT）测量 LAA 基底的可行性。对 15 例接受胸腔镜 LAA 夹闭术的患者进行了 LAA 基底测量的回顾性分析。随后，我们将放置的夹闭器大小与影像学获取的 LAA 基底大小进行比较，以回顾性评估术中大小。我们成功地将 VR 平台应用于测量 LAA 基底大小。CT（23.8mm，四分位间距[IQR]22.3 至 26.4mm）和心内 VR（23.4mm，IQR 21.6 至 25.5mm）测量的 LAA 基底大小中位数无显著差异（ = 0.416）。术者视图下 LAA 基底的 VR 测量值（25.7mm，IQR 24.2 至 29.2）明显高于二维 CT（ = 0.037）和心内 3D VR（ < 0.05）测量值。所有测量值与放置的夹闭器大小均有显著差异（ < 0.05）。无夹闭器位置不当相关事件。沉浸式 VR 是获取 LAA 基底大小解剖学信息的一种可行方法。在这项回顾性分析中，LAA 基底的 CT 和 VR 测量值与术中放置的 LAA 夹闭器有显著差异，表明术中测量时存在潜在的过大尺寸。使用直观的 3D VR 成像可能是一种辅助准确术前 LAA 基底大小的有用方法，并可能防止过大尺寸。
