Abstract：
Background: Complex aortic anatomy needs careful preoperative planning in which a patient-tailored approach with novel immersive techniques could serve as a valuable addition to current preoperative imaging. This pilot study aimed to investigate the technical feasibility of virtual reality (VR) as an additional imaging tool for preoperative planning in ascending aortic surgery. Methods: Ten cardiothoracic surgeons were presented with six patients who had each undergone a recent repair of the ascending aorta. Two-dimensional computed tomography images of each patient were assessed prior to the VR session. After three-dimensional (3D) VR rendering and 3D segmentation of the ascending aorta and aortic arch, the reconstructions were analyzed by each surgeon in VR via a head-mounted display. Each cardiothoracic surgeon completed a questionnaire after each planning procedure. The results of their assessments were compared to the performed operations. The primary endpoint of the present study was a change of surgical approach from open to clamped distal anastomosis, and vice versa. Results: Compared with conventional imaging, 80% of surgeons found that VR prepared them better for surgery. In 33% of cases (two out of six), the preoperative decision was adjusted due to the 3D VR-based evaluation of the anatomy. Surgeons rated CardioVR usefulness, user-friendliness, and satisfaction with median scores of 3.8 (IQR: 3.5-4.1), 4.2 (IQR: 3.8-4.6,) and 4.1 (IQR: 3.8-4.7) on a five-point Likert scale, respectively. Conclusions: Three-dimensional VR imaging was associated with improved anatomical understanding among surgeons and could be helpful in the future preoperative planning of ascending aortic surgery.
摘要：
背景：复杂的主动脉解剖需要仔细的术前计划，其中采用新颖的沉浸式技术为患者量身定制的方法可以作为当前术前成像的宝贵补充。这项初步研究旨在研究虚拟现实（VR）作为升主动脉手术术前计划的附加成像工具的技术可行性。方法：10名心胸外科医师介绍了6例患者，这些患者均接受了最近的升主动脉修复。在VR会话之前评估每位患者的二维计算机断层扫描图像。在三维（3D）VR渲染和升主动脉和主动脉弓的3D分割后，重建由每位外科医生通过头戴式显示器在VR中进行分析.每个心胸外科医生在每个计划程序后都完成了问卷调查。将他们的评估结果与所执行的操作进行比较。本研究的主要终点是手术方式从开放到夹钳远端吻合的改变，反之亦然。结果:与常规影像学相比,80％的外科医生发现VR为手术做好了更好的准备。在33%的病例中（6个中有2个），由于基于3DVR的解剖结构评估,术前决策得到了调整.外科医生评价心脏VR的有用性，用户友好性，和满意度中位数为3.8（IQR：3.5-4.1），4.2（IQR：3.8-4.6，）和4.1（IQR：3.8-4.7），分别。结论：三维VR成像与外科医生对解剖学的理解有关，并可能有助于未来升主动脉手术的术前计划。
