Design, development, and evaluation of an immersive augmented virtuality training system for transcatheter aortic valve replacement

Strong procedural skills are essential to perform safe and effective transcatheter aortic valve replacement (TAVR). Traditional training takes place in the operating room (OR) on real patients and requires learning new motor skills, resulting in longer procedure times, increased risk of complications, and greater radiation exposure for patients and medical personnel. Desktop-based simulators in interventional cardiology have shown some validity but lack true depth perception, whereas head-mounted display based Virtual Reality (VR) offers intuitive 3D interaction that enhances training effectiveness and spatial understanding. However, providing realistic and immersive training remains a challenging task as both lack tactile feedback. We have developed an augmented virtuality (AV) training system for transfemoral TAVR, combining a catheter tracking device (for translational input) with a simulated virtual OR. The system enables users to manually control a virtual angiography system via hand tracking and navigate a guidewire through a virtual patient up to the aortic valve using fluoroscopic-like imaging. In addition, we conducted a preliminary user study with 12 participants, assessing cybersickness, usability, workload, sense of presence, and qualitative factors. Preliminary results indicate that the system provides realistic interaction for key procedural steps, making it a suitable learning tool for novices. Limitations in angiography system operation include the lack of haptic resistance and usability limitations related to C-arm control, particularly due to hand tracking constraints and split attention between interaction and monitoring. Suggestions for improvement include catheter rotation tracking, expanded procedural coverage, and enhanced fluoroscopic image fidelity.