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. 2022 Apr 25:9:836200.
doi: 10.3389/fcvm.2022.836200. eCollection 2022.

A Novel 3D Visualized Operative Procedure in the Single-Stage Complete Repair With Unifocalization of Pulmonary Atresia With Ventricular Septal Defect and Major Aortopulmonary Collateral Arteries

Hailong Qiu  1   2 , Shusheng Wen  1   2 , Erchao Ji  1   2 , Tianyu Chen  1   2 , Xiaobing Liu  1   2 , Xiaohua Li  1   2 , Yun Teng  1   2 , Yong Zhang  1   2 , Rong Liufu  2 , Jiawei Zhang  2 , Xiaowei Xu  2 , Jimei Chen  1   2 , Meiping Huang  2 , Jianzheng Cen  1   2 , Jian Zhuang  1   2
Affiliations

A Novel 3D Visualized Operative Procedure in the Single-Stage Complete Repair With Unifocalization of Pulmonary Atresia With Ventricular Septal Defect and Major Aortopulmonary Collateral Arteries

Hailong Qiu et al. Front Cardiovasc Med. .

Abstract

Objectives: Pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries (PA/VSD/MAPCAs) is a relatively rare, complex, and heterogeneous congenital heart disease. As one of the effective treatments, the midline unifocalization strategy still remains complicated and challenging due to the diverse forms of MAPCAs and pulmonary arteries. The purpose of this study is to summarize our experience of a novel three-dimensional (3D) visualized operative procedure in the single-stage complete repair with unifocalization and to clarify the benefits it may bring to us.

Methods: We described our experience of the 3D visualized operative procedure such as 3D printing, virtual reality (VR), and mixed reality (MR) technology in patients with PA/VSD/MAPCAs who underwent a single-stage complete repair with unifocalization. The data from the patients who underwent this procedure (3D group) and those who underwent the conventional procedure (conventional group) were compared.

Results: The conventional and 3D groups included 11 patients from September 2011 to December 2017 and 9 from January 2018 to March 2021, respectively. The baseline characteristics such as age, body weight, preoperative saturation, the anatomy of the pulmonary arteries and MAPCAs, the Nakata index, and TNPAI had no statistical significance. All 9 patients in the 3D group were operated only through a median sternotomy, while 8 cases (72.7%) in the conventional group needed another posterolateral thoracotomy (p = 0.001). In the 3D group, the CPB time was shorter (93.2 ± 63.8 vs. 145.1 ± 68.4 min, p = 0.099), and the median pre-CPB time per MAPCAs was significantly shorter [25.7 (14.0, 46.3) vs. 65 (41.3, 75.0) min, p = 0.031]. There was no early death in the 3D group, while there were 3 in the conventional group (0 vs. 27.3%, p = 0.218).

Conclusion: The novel 3D visualized operative procedure may help improve the performance of the single-stage complete repair with the midline unifocalization of PA/VSD/MAPCAs and help shorten the dissecting time of the MAPCAs. It may promote the routine and successful application of this strategy in more centers.

Keywords: major aortopulmonary collateral arteries; mixed reality; preoperative planning; pulmonary atresia; three-dimensional printing; ventricular septal defect; virtual reality.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flows of the 3D visualized (orange line) and the conventional (blue line) operative procedures. (A) CT Multiplanar Reconstruction to review the anatomy. (B,C) CT Volume rendering with and without the thorax part. (D–F) Preoperative evaluation with the section, rotation, and separation of the VR models. (G,H) Surgical planning with the VR and 3D solid models. (I,J) Determination of the MAPCAs location by coinciding the virtual and real hearts on the Hololens device (I) and anatomical review by observing the 3D solid model placed next to the operating table (J) during the operation.
See this image and copyright information in PMC

References

    1. Mainwaring RD, Patrick WL, Roth SJ, Kamra K, Wise-Faberowski L, Palmon M, et al. Surgical algorithm and results for repair of pulmonary atresia with ventricular septal defect and major aortopulmonary collaterals. J Thorac Cardiovasc Surg. (2018) 156:1194–204. 10.1016/j.jtcvs.2018.03.153 - DOI - PubMed
    1. D'Udekem Y, Alphonso N, Norgaard MA, Cochrane AD, Grigg LE, Wilkinson JL, et al. Pulmonary atresia with ventricular septal defects and major aortopulmonary collateral arteries: unifocalization brings no long-term benefits. J Thorac Cardiovasc Surg. (2005) 130:1496–502. 10.1016/j.jtcvs.2005.07.034 - DOI - PubMed
    1. Reddy VM, Liddicoat JR, Hanley FL. Midline one-stage complete unifocalization and repair of pulmonary atresia with ventricular septal defect and major aortopulmonary collaterals. J Thorac Cardiovasc Surg. (1995) 109:832–44. 10.1016/S0022-5223(95)70305-5 - DOI - PubMed
    1. Griselli M, McGuirk SP, Winlaw DS, Stumper O, de Giovanni JV, Miller P, et al. The influence of pulmonary artery morphology on the results of operations for major aortopulmonary collateral arteries and complex congenital heart defects. J Thorac Cardiovasc Surg. (2004) 127:251–8. 10.1016/j.jtcvs.2003.08.052 - DOI - PubMed
    1. Davies B, Mussa S, Davies P, Stickley J, Jones TJ, Barron DJ, et al. Unifocalization of major aortopulmonary collateral arteries in pulmonary atresia with ventricular septal defect is essential to achieve excellent outcomes irrespective of native pulmonary artery morphology. J Thorac Cardiovasc Surg. (2009) 138:1269–75. 10.1016/j.jtcvs.2009.08.011 - DOI - PubMed