Surgical Planning for Mitral Valve Repair

Mitral valve repair is hard. Very hard. Although it's the most effective technique for eliminating mitral regurgitation, this procedure can be challenging for even experienced cardiac surgeons. In addition to the difficulties presented by a limited intraoperative field of view, currently the heart must be stopped in nearly all procedures. As a result, the surgeon is unable to observe the precise effects of the implemented repair and instead must predict the closed valve shape using past experience as a guide. Consequently, surgeons who perform fewer operations in a given year are significantly more likely to replace the valve with a prosthetic, a simpler technique known to have clinically inferior results, rather than repair it.

A surgical planner with a physically accurate tissue model, such as the system we have developed, ameliorates this situation by allowing the surgeon to virtually implement a variety of candidate procedures and then visualize and evaluate post-repair valve function. With a patient-specific valve model and a Sensable PHANTOM Desktop, the user is able to interact in real-time with the virtual valve. While this necessitates a 1kHz update rate for smooth user-model interaction, using a mass-spring tissue membrane model we are able to simulate valve mechanics at haptic rates. Together, this enables not only the testing of various repair techniques, but also the evaluation of the valve pathology.



Neil A. Tenenholtz, Peter E. Hammer, Robert J. Schneider, Nikolay V. Vasilyev, and Robert D. Howe
On the Design of an Interactive, Patient-Specific Surgical Simulator for Mitral Valve Repair
Proceedings of the IEEE/RSJ International Conference on Intelligent Robots and Systems (IROS 2011).