Augmented reality image guidance improves navigation for beating heart mitral valve repair

Michael W.A. Chu, John Moore, Terry Peters, Daniel Bainbridge, David McCarty, Gerard M. Guiraudon, Chris Wedlake, Pencilla Lang, Martin Rajchl, Maria E. Currie, Richard C. Daly, Bob Kiaii

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


OBJECTIVE: Emerging off-pump beating heart valve repair techniques offer patients less invasive alternatives for mitral valve (MV) repair. However, most of these techniques rely on the limited spatial and temporal resolution of transesophageal echocardiography (TEE) alone, which can make tool visualization and guidance challenging. METHODS: Using a magnetic tracking system and integrated sensors, we created an augmented reality (AR) environment displaying virtual representations of important intracardiac landmarks registered to biplane TEE imaging. In a porcine model, we evaluated the AR guidance system versus TEE alone using the transapically delivered NeoChord DS1000 system to perform MV repair with chordal reconstruction. RESULTS: Successful tool navigation from left ventricular apex to MV leaflet was achieved in 12 of 12 and 9 of 12 (P = 0.2) attempts with AR imaging and TEE alone, respectively. The distance errors of the tracked tool tip from the intended midline trajectory (5.2 ± 2.4 mm vs 16.8 ± 10.9 mm, P = 0.003), navigation times (16.7 ± 8.0 seconds vs 92.0 ± 84.5 seconds, P = 0.004), and total path lengths (225.2 ± 120.3 mm vs 1128.9 ± 931.1 mm, P = 0.003) were significantly shorter in the AR-guided trials compared with navigation with TEE alone. Furthermore, the potential for injury to other intracardiac structures was nearly 40-fold lower when using the AR imaging for tool navigation. The AR guidance also seemed to shorten the learning curve for novice surgeons. CONCLUSIONS: Augmented reality-enhanced TEE facilitates more direct and safe intracardiac navigation of the NeoChord DS tool from left ventricular apex to MV leaflet. Tracked tool path results demonstrate fourfold improved accuracy, fivefold shorter navigation times, and overall improved safety with AR imaging guidance.

Original languageEnglish (US)
Pages (from-to)274-281
Number of pages8
JournalInnovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
Issue number4
StatePublished - 2012


  • Augmented reality image guidance
  • Chordal reconstruction
  • Echocardiography
  • Mitral valve repair
  • Off-pump beating heart surgery

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine


Dive into the research topics of 'Augmented reality image guidance improves navigation for beating heart mitral valve repair'. Together they form a unique fingerprint.

Cite this