The Advanced PCI module includes 10 virtual reality medicall cases that allow the user to practice navigating different sizes and shapes of catheters over the aortic arch and into the respective left or right coronary artery. Thesurgical cases include various aortic arch sizes such as dilated aortas, different coronary artery structures, different types of arterial lesions, both calcified and non-calcified, and more complicated presentations such as chronic total occlusions, acute myocardial infarctions, and saphenous vein grafts. Intentional or accidental complications such as dampening at the ostia of the coronary artery, dissections, perforations, stent embolization due to undersizing, thrombus dislodgement, spasm, and bradycardia are also possible.

Virtual Reality Medical Patient

Due to the different anatomical variations of the virtual patients, users may need to select a different guide catheter, guidewire, and/or balloon or stent to improve the success of navigating to the desired location and manipulating the lesion(s). In addition, time may be more of an initial factor if the patient presents with an acute myocardial infarction. For successful completion of the virtual surgery, one should carefully cross the lesion, such as in the case of a chronic total occlusion, dilate the intended lesion(s) to improve flow to the coronary artery, and then instill contrast through the dilated lesion(s) to verify anticipated flow to the remainder of the coronary tree. All delivery instruments, including balloons, stents, and wires, should be carefully withdrawn to minimize complications such as dissections or perforations.

Realistic Medical Simulation

The 3D heart model incorporates three different aortic arches — small, normal range, and dilated. With saphenous vein grafts, the clinician has additional ostia to cannulate. Additionally, the calcified and non-calcified lesions are distributed throughout the anatomies. Chronic total occlusions and dislodged thrombus increase the challenge, which requires thinking through the plan on how to intervene. Clinicians will visualize and feel the lesions as they navigate devices through them, and they will also feel dilated balloons and stents wedged within the anatomy. Additionally, realistic scenarios such as buckling of the catheter — either due to it being an inappropriate shape or size for the coronary ostia or because of the inability of the coronary arteries to provide enough support for successful navigation of a wire — adds to a realistic level of complexity.

Complications and Management of Complications

The Advanced Coronary Interventions module has an extensive amount of complications that the interventionalist will have to address or attempt to avoid. The clinician has a wide variety of adjunct therapies for facilitating complications management — both medication, such as Adenosine and Nitro-Glycerin, and non-medication, such as defibrillation and temporary pacing leads. All selections will be tracked and displayed in the evaluation metrics, including decisions such as under- or over-dosing of medications.

Objective Evaluation

After the case is completed, the user can examine the surgical simulator’s Metrics, or evaluation, page to view objective criteria tracked during the virtual surgery, including total fluoroscopy time, final placement, whether complications were elicited and addressed appropriately, as well as percentage of the lesion opening compared to pre-procedure percentage, and if the entire lesion length was covered by the stent.

The PCI module also includes cases for coronary interventions.