Mixed reality for preoperative planning and intraoperative assistance of surgical correction of complex congenital heart defects.

Objectives: Mixed reality (MixR) is an innovative visualization tool that presents virtual elements in a real-world environment, enabling real-time interaction between the user and the combined digital/physical reality. We aimed to explore the feasibility of MixR in enhancing preoperative planning and intraoperative guidance for the correction of various complex congenital heart defects (CHDs).

Methods: Patients underwent cardiac computed tomography or cardiac magnetic resonance and segmentation of digital imaging and communications in medicine (DICOM) images was performed. Three-dimensional models were then uploaded into a MixR headset (Microsoft HoloLens 2), displayed as holograms, and used for preoperative navigation of cardiac anatomy and intraoperative assistance of surgical steps.

Results: We adopted MixR in 5 different clinical scenarios: minimally-invasive partial anomalous pulmonary venous connection repair of 5 anomalous veins; intra-extracardiac Fontan completion in right atrial isomerism and dextrocardia; arterial switch operation for transposition of the great arteries with abnormal coronary pattern in situs inversus; complete unifocalization of major aortopulmonary collateral arteries; total artificial heart implantation for failing Fontan. Preoperative MixR allowed a comprehensive understanding of complex anatomical relationships and spatial mapping, using immersive 3D navigation. As a result, the surgeon was able to simulate the surgical approach and plan the best surgical strategy. Intraoperatively, MixR provided a real-time virtual map by overlaying holograms onto the patient's anatomy.

Conclusions: MixR represents a promising tool for preoperative planning and 3D visualization in complex CHDs, however, its systematic adoption in the intraoperative setting requires further implementation of current hardware technology and software versatility.