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J Thorac Cardiovasc Surg 2008;135:1334-1341
© 2008 The American Association for Thoracic Surgery

Evolving Technology

Stereoscopic vision display technology in real-time three-dimensional echocardiography-guided intracardiac beating-heart surgery

^a Department of Cardiac Surgery, Children's Hospital Boston, Harvard Medical School, Boston, Mass
^b Division of Engineering and Applied Sciences, Harvard University, Cambridge, Mass
^c Ultrasound Division, Philips Medical Systems, Andover, Mass

Received for publication June 26, 2007; revisions received November 16, 2007; accepted for publication December 6, 2007.

^_* Address for reprints: Pedro J. del Nido, MD, Department of Cardiac Surgery, Children's Hospital Boston, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115. (Email: pedro.delnido{at}tch.harvard.edu).

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.

Conclusion: 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.

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