Three-Dimensional Visualization for Double Outlet Right Ventricle Surgical Planning: 3D Printed Models vs. 3D Virtual Reality Reconstruction

Abstract

Objectives: In double outlet right ventricle (DORV) both the pulmonary artery and the aorta originate predominantly from the right ventricle (RV) and a ventricular septum defect (VSD) is present. Each DORV patient requires an individual surgical approach. In complex cases the optimal surgical approach may be difficult to assess based on conventional 2D imaging. The aim of this study is to assess the added value of 3D printed and 3D Virtual Reality (VR) models used for surgical planning in DORV patients, supplementary to the gold standard 2D imaging modalities, in a retrospective clinical setting. Methods: Five patients with different DORV-subtypes were selected, of which 3D prints and good quality cardiac CT scans were available. Participants were twelve congenital cardiac surgeons and paediatric cardiologists, from 3 different hospitals. Participants were shown the 2D images first, after which they assessed the VR and 3D model in random order. After each imaging method, a questionnaire was filled in on the visibility of essential structures, feasibility of four-chamber repair, and the surgical plan. Results: Spatial relationships were generally best visible using 3D methods. The feasibility of VSD patch closure was accessible best on the VR 3D reconstructions (good visible: VR 92%, 3D print 66%, and US/CT 46%, P<.01). Moreover, based on the three different visualisation modalities, surgical plans were proposed. The proportion of proposed surgical plans similar to the performed surgical approach was 72% for plans based on conventional imaging, 85% for plans based on 3D printing, and 87% for plans based on VR visualisation.Conclusions: In this study, we determined that the use of both 3D modalities is very useful and participants could visualize spatial relationships better compared with conventional 2D imaging. Moreover, based on the 3D visualisations, the proposed surgical plans were corresponding more to the actual performed surgery. However, still some research is needed to fully implement 3D visualisation in clinical practise.