Augmented Reality and Computational Simulations for the Preprocedural Planning of Transcatheter Aortic Valve Replacement After Previous Transcatheter Mitral Valve Replacement

Transcatheter aortic valve replacement (TAVR) has become the preferred treatment for patients with aortic stenosis (AS) at high surgical risk. However, TAVR is challenging in patients with a pre-existing mitral valve prosthesis, such as a transcatheter mitral valve replacement (TMVR), due to the likelihood of device interference. This study explores the feasibility and safety of performing TAVR in a patient with a pre-existing TMVR procedure using 3D printing, augmented reality (AR) and computational simulations to optimize preprocedural planning. Computational modeling allowed predictions of the spatial relationship between the TAVR and TMVR devices. The simulation output was therefore used as input for augmented visualization of the device interference. The 3D printing of an anatomical replica was used to physically simulate the procedure, ensuring that no significant interference would occur during heart function. The results demonstrated a safe distance of 6.4 mm between the TAVR and TMVR devices, and no functional interference was observed during simulated cardiac cycles. The use of AR in the operating room enhanced the understanding of device positioning, offering a new dimension of precision of the complex cardiovascular intervention. This study concludes that integrating AR, 3D printing, and computational simulations into preprocedural planning for high-risk structural intervention can significantly improve procedural outcomes by enhancing accuracy, safety, and operator confidence.