Stephan Jacobs, David Holzhey, Friedrich Wilhelm Mohr, Volkmar Falk.
Heartcenter Leipzig, Leipzig, Germany.
Objektive: Aim of the study was to investigate the potential value of augmented reality enhanced transesophageal echocardiography (TEE) for determining optimal annuloplasty size in minimally invasive mitral valve repair.
Methods: In patients undergoing elective minimally invasive mitral valve repair, a 3 dimensional reconstruction of the mitral valve was performed using TEE. A modified 4D valve assessment software was used to create 3D CAD-models of standard annuloplasty-rings (28 to 36 mm) which were stored in a digital database. These virtual 3D annuloplasty ring templates were overimposed on the preoperative 3D-TEE reconstructions of the mitral valve (Fig. 1) and results were compared to conventional sizing under direct vision. In addition a post-hoc validation of the 3D-models was performed using the implanted rings as a control. The echocardiographer was blinded for the implanted ring size.
Results: 50 patients were included in the study. The correlation between the selected 3D annuloplasty ring templates and the implanted annuloplasty ring size was 0.83. 30 ring templates showed no differences and 20 rings differed ±2mm in size. Postoperatively, the validation protocol revealed a correlation of 0.94 between the size of the ring templates and the implanted annuloplasty prostheses.
Conclusions: Augmented reality enhanced TEE for determining optimal annuloplasty ring size during minimally invasive mitral valve repair correlates well with the surgical sizing. A prospective randomized study is necessary to evaluate the clinical value of this new approach to determine the optimal annuloplasty-ring. 
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