Surgical Simulation: Peripheral Coronary Interventions (PCI)

The Percutaneous Coronary Intervention (PCI) modules for the CathLabVR™ Surgical Simulator include both Coronary Interventions and Advanced Coronary Interventions. Each module has 10 progressively difficult cases that provide a broad variety of anatomic and pathologic variations to enhance learning. Each case includes a patient history and pre-procedure steps that have been completed to prepare the virtual patient.

Simulation of Percutaneous Coronary Interventions

The CathLabVR surgical simulator's PCI modules allow the user to practice navigation of a wide variety of catheters with different tip shapes and sizes; instill contrast for observing location and severity of lesions; practice balloon dilation (angioplasty), stent placement, or both; and in most cases resolve complications within a virtual 3D model of a beating heart. Computer-generated, real-time fluoroscopic images of the virtual reality patient permit users to visualize the selected catheters, guidewires, balloons, stents, and other interventional catheterization instruments.

Virtual Reality Medical Simulation

The CathLabVR Surgical Simulator’s fluoroscopic image display can be rotated or magnified, and cine video loops or still images may be recorded as in a real catheterization lab. Additionally, a virtual aide, an image of the virtual patient’s aortic arch and coronary artery may be displayed to assist with identifying significant anatomy and navigating interventional guide wires, balloons, stents, and other devices.

High-fidelity Surgical Simulations

In addition to high-fidelity visual images, the CathLabVR surgical simulator provides the user with realistic tactile feedback, which is integrated with visual cues. The user will actually feel the forces encountered when navigating interventional wires, balloons, and stents; crossing lesions; and deploying devices within the virtual patient’s anatomy.

Endovascular Catheters, Balloons, Leads, Guidewires

The CathLabVR surgical simulator allows various types and shapes of instruments, such as Amplatz, Judkins, or Hockey stick catheters, which are especially helpful for navigating through torturous anatomy, when extra support is needed, or when the lesion is hard to reach. Examples of these locations include anterior take offs, shepard’s hook, or saphenous vein grafts. Users can shape or customize guidewires to help navigate the balloons and stents to the location of the lesion. Different types of balloons can be selected for calcified lesions and different covered stents are available.

Training for Endovascular Complications

The CathLabVR Surgical Simulator supports training in proper tool selection and in tool-handling techniques within the virtual anatomy. As in a real procedure, improper technique or tools can cause complications including dissections, perforations, stent embolization, thrombus dislodgement, bradycardia, and spasm. For the simulated cases to be completed, the CathLabVR surgical simulator’s training procedures require that complications be recognized and treated. Real-time ECG, blood pressure, heart rate, and arterial pressure wave sensing are indicated to monitor the virtual patient’s status throughout the case.

Realistic Virtual Reality Patient Responses

The virtual reality patient responds to inappropriate actions with verbal complaints, changes in vital signs and pressure wave, and in some instances, changes in the contrast flow within the coronary arteries. Resolution of most of the complications are through placement of stents or balloons at the appropriate locations within the coronary artery, instilling medications through the adjunct therapy menu, and prolongation of the simulated patient’s life by providing non medication adjunct therapy such as CPR or defibrillation. If the complication is resolved, vital signs and contrast flow will restore to normal. Movement of the heart and the diaphragm can be observed on the real-time simulated fluoroscopy display.

Evaluation of Disease

The PCI module allows the user to evaluate the lesions within the coronary artery using cine and still images (if cines are captured). Users can capture fluoroscopic images from different angles to evaluate the length, percent of stenosis, and sometimes type of lesion, such as a calcified lesion. Using cines and stills, users can also perform quantitative coronary angiography, which will assist in the determination of the size of the balloon or stent to be placed at the site of the lesion.

Training in Surgical Technique

The PCI module includes training on placing balloon(s) and/or stent(s) in stable and unstable patients by allowing the clinician to decide on choice of catheter, guide wire, balloon, stent, and in the advanced module, embolic protection devices. Depending on the underlying anatomy, these decisions will impact the time to successfully complete the case, as well as to correct the problematic lesion(s).

Objective, Automated Medical Training Evaluation

After a case is completed, the user may access the surgical simulator’s Metrics page, which reports case parameters including total fluoroscopy time, amount of contrast used, complications encountered and treated, and percentage of change at the lesion due to angioplasty or stent placement. These metrics allow the user and system administrators to evaluate performance for training or certification purposes.