"can mixed reality improve the results of tavi?"

Background and Aim: Although the rate of TAVI–related complications has consistently reduced during the last decade, vascular complications still occur, and can be serious. Mixed reality (MR) can be defined as a three–dimensional real world simulation allowing the user to directly interact with it. The present study was designed to explore the potential of MR in facilitating the vascular access and navigation with large–bore devices. Methods 3D holograms were generated from the CT’s of 20 TAVI patients (age 81.2±6.8 years, STS score 5.1±2.1) and made available to 2 surgeons in training. Different layers were generated: Skin, Arterial tree, and Calcium. A needle simulator was also available. The vascular puncture was echo guided. 2 percutaneous suture system were used to secure the hemostasys. Results All the procedures were carried out through the planned access. In 2 patients intravascular lythoplasty was used. There were no vascular complications, and procedural success was 100%. A single puncture was necessary to obtain vascular access in 19/20 patients and in 2 cases the echo was not used, and the operator decided to switch to angio–guided puncture due to the bad quality of the echo images that were in contrast with MR. Conclusion MR can be used to predict the optimal puncture site for TAVI. The interactive 3D holograms can be used to identify relevant repere on the skin and to reduce the rate of vascular complications and could become a powerful tool for procedural planning, training and remote proctoring.