Medics in Canada have carried out the world’s first heart valve replacement using the Microsoft HoloLens headset to bring the operating room to a remote surgeon for virtual support during live procedures.

The Jewish General Hospital (JGH) with Auger Groupe Conseil (AGC) and Medtronic Canada have pioneered the first application of the Microsoft HoloLens for use in real-time, extended reality clinical support of a minimally invasive heart procedure.

In March, this partnership completed the first end-to-end remotely guided transcatheter aortic valve implant and replacement, a minimally invasive procedure to replace a heart valve. Sam Radhakrishnan, the proctor or teaching specialist in Toronto, was able to remotely guide the JGH team of Ali Abualsaud, Nathan Messas and Emmanuel Moss through the procedure in real time at the JGH in Montreal, using the intra-operative extended reality platform.

The Microsoft HoloLens 2 headset enables bidirectional remote viewing in real time. The use of extended reality headsets and glasses has grown during the pandemic because of the limitations on travel to and within a hospital.

A modular system allows the remote proctor to view the cardiac event monitors in real time, without requiring the active clinician wearing the HoloLens 2 to look up at the screens. A three-dimensional clinical pathway overlay depicts step-by-step instructions for a specific surgical procedure.

“We think of it as bringing the operating room to the surgical specialist,” said Lawrence Rudski, director of the Azrieli Heart Center. “Rather than coordinating resources to bring a specialist to another hospital for training, now we can greatly simplify the process, which can help improve the timeliness of patient care, especially in an emergency. There are significant advantages to using a real-time, extended-reality system for both the proctor and the clinician on the receiving end, such as having the same view, which is almost better than being in the same, often crowded, room. In addition, this platform has the flexibility to be expanded to many other types of procedures.”

During the initial peak of the pandemic in spring 2020, the JGH was designated as a lead Covid-19 treatment site. The ensuing staffing challenges, combined with travel restrictions, required effective and remote training. In collaboration with Quebec engineering firm AGC, the JGH piloted the use of the Microsoft HoloLens to help train and redeploy staff.

“We chose to work with Microsoft mainly because of the HoloLens 2’s unmatched performance and in part because of the security offered by their encryption design,” said Marcel Lafontaine, CEO of AGC. “We are very proud of our work in combining the mixed reality experience of voice, video and a 3D overlay with no lag time. This is unique plug-and-play, and we’re very excited to see it deployed in such an impactful way for clinicians, and ultimately for patients.”

The initial success of this project led to developing remote support in a complex clinical pathway and connectivity to medical imaging with the help of medical device company Medtronic.

“We are thrilled to be able to contribute our expertise to this unique partnership and are looking forward to seeing this collaboration extend to other clinical pathways,” said Richard Paré, regional business director at Medtronic Canada. “This innovative platform can enable health systems to optimise surgical resources and scheduling, while protecting staff, during the pandemic but also afterwards as they shift their focus to addressing the surgical backlog.”

The partnership is planning additional applications in the field of cardiovascular medicine and in other areas.