Stereoscopic vision display technology in real-time three-dimensional echocardiography-guided intracardiac beating-heart surgery.
OBJECTIVE
Stereoscopic vision display technology has been shown to be a useful tool in image-guided surgical interventions. However, the concept has not been applied to 3-dimensional echocardiography-guided cardiac procedures. We evaluated stereoscopic vision display as an aid for intracardiac navigation during 3-dimensional echocardiography-guided beating-heart surgery in a model of atrial septal defect closure.


METHODS
An atrial septal defect (6 mm) was created in 6 pigs using 3-dimensional echocardiography guidance. The defect was then closed using a catheter-based patch delivery system, and the patch was attached with tissue mini-anchors. Stereoscopic vision was generated with a high-performance volume renderer with stereoscopic glasses. Three-dimensional echocardiography with stereoscopic vision display was compared with 3-dimensional echocardiography with standard display for guidance of surgical repair. Task performance measures for each anchor placement (N = 32 per group) were completion time, trajectory of the tip of the anchor deployment device, and accuracy of the anchor placement.


RESULTS
The mean time of the anchor deployment for stereoscopic vision display group was shorter by 44% compared with the standard display group: 9.7 +/- 0.9 seconds versus 17.2 +/- 0.9 seconds (P < .001). Trajectory tracking of the anchor deployment device tip demonstrated greater navigational accuracy measured by trajectory deviation: 3.8 +/- 0.7 mm versus 6.1 +/- 0.3 mm, 38% improvement (P < .01). Accuracy of anchor placement was not significantly different: 2.3 +/- 0.3 mm for the stereoscopic vision display group versus 2.3 +/- 0.3 mm for the standard display group.


CONCLUSIONS
Stereoscopic vision display combined with 3-dimensional echocardiography improved the visualization of 3-dimensional echocardiography ultrasound images, decreased the time required for surgical task completion, and increased the precision of instrument navigation, potentially improving the safety of beating-heart intracardiac surgical interventions.
Department of Cardiac Surgery, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, USA.
Nikolay V
NV
Vasilyev
Paul M
PM
Novotny
Joseph F
JF
Martinez
Hugo
H
Loyola
Ivan S
IS
Salgo
Robert D
RD
Howe
Pedro J
PJ
del Nido
D000818:Animals; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002315:Cardiopulmonary Bypass; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods; D003867:Depth Perception; D004195:Disease Models, Animal; D019560:Echocardiography, Three-Dimensional; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging* / Q000601:surgery*; D011184:Postoperative Period; D011897:Random Allocation; D012680:Sensitivity and Specificity; D013552:Swine; D013647:Task Performance and Analysis