Computer Assisted Ventricular Surgery (CAVE): a Novel Tool to Improve Outcome of Ventricular Restoration Surgery

Objectives: The clinical data of surgical ventricular restoration are controversial (Stich trial versus Registry Data). Accurate assessment of left ventricular morphology and function as well as careful patient selection and operation planning may optimize these outcomes. We developed a a computer based system for preoperative planning of surgical ventricular reconstruction and to predict postoperative outcome.

Methods: Multimodal imaging (3D echocardiography, CT, or MRI) data were used to generate a 4D deformable model of left ventricular volume and wall. The model was used to determine resection lines, path geometry and to predict postoperative volumes. Postoperative imaging data were used to validate the predictive value of the planning system and to assess postoperative outcome. The elastic models were also provided by a 3D printer to train the surgeon for the intraoperative situation. The system was also implemented in a hybrid operating theater to allow a rapid feedback on the base of intraoperative measurements.

Results: 7 Patients (68 ± 7 ys) with post infarction left ventricular aneurysms underwent computer assisted ventricular surgery (CAVE). Thirty day mortality was 0%. Mean ejection fraction improved by 70% (18 ± 4 vs 31 ± 3%, p< 0.01), LV volumes, mainly end-diastolic volumes (265 ± 41 ml vs172 ± 23, p< 0.01) improved also significantly. In comparison to a historical control, cross-clamp and operation times improved significantly. In comparison to postoperative imaging data, the computer model provided an accurate prediction of postoperative volumes and ejection fraction

Conclusions: Computer assisted ventricular surgery using a novel computer based simulation system markedly improves clinical outcomes, allows an accurate prediction of postoperative results and facilitates the surgical procedure.