Heart surgery filmed in 3D at Montreal hospital could be used to train future surgeons

As the doctor moves his instrument, coloured areas appear on the ventricle: the white ones let the current through normally, the yellow and green and red ones are more problematic, and the purple ones are the ones we need to worry about today, since that's where we'll find the damaged area that needs to be destroyed to improve the patient's quality of life. THE CANADIAN PRESS/Ryan Remiorz

A delicate cardiac procedure was filmed in 3D at Montreal's Sacré-Coeur Hospital earlier this week, with the aim of creating a virtual reality environment that will initially be used for training purposes, but could one day also be used to provide remote advice.

The Canadian Press was exclusively invited to the event. Technicians from the firm Abbott were on hand to film the procedure led by cardiac electrophysiologist Alexios Hadjis to correct ventricular tachycardia in a 67-year-old patient.

In terms of difficulty and complexity, said Dr. Hadjis a few minutes before going back to his patient, "I'd say it's an 8 or a 9, for sure" on a scale of 1 to 10.

He's apparently modest: a colleague confided said after his departure that she could hardly imagine a more complex procedure than the one awaiting them that morning.

Ventricular tachycardia is a potentially fatal cardiac arrhythmia that occurs when a damaged area of the heart causes abnormally rapid heartbeats by interfering with the electrical current on which the organ depends.

In this case, the after-effects of a heart attack several years ago came back to haunt the patient earlier this year. The patient is protected by a defibrillator that prevents him from dying suddenly, explained Dr. Hadjis, but the aim of the operation is to avoid repeated shocks.

The procedure, which aims to neutralize the problem area by "burning" it, had been underway for almost 90 minutes when The Canadian Press entered the small control room adjacent to the room where Dr. Hadjis and his team were working around the sleeping patient. Abbott's 360-degree camera, the size of a bowling ball and perched on a tripod, films everything that happens.

There are enough screens in the two rooms to make an avid gamer green with envy. Several of them show the inside of the patient's left ventricle, which Dr. Hadjis is mapping using a catheter inserted in the groin and threaded through to the heart.

As he moves his instrument, coloured areas appear on the ventricle: the white ones let the current through normally, the yellow, green and red ones are more problematic, and the purple ones are the ones we need to worry about, since that's where doctors will find the damaged area that needs to be destroyed to improve the patient's quality of life.

THE GUIDE

Judith Bérubé, head nurse of Sacré-Cœur's coronary, hemodynamics and electrophysiology unit, is the guide through the spaceship-like environment, explaining events like an analyst at a soccer game.

She draws attention to a screen showing that the patient's pressure has just dropped. "It's a bit low," she says, "but it's still compatible with life. So much the better."

A few minutes later, the same screen warns that the patient is now in cardiac arrest. But the screen is really the only one to panic; the humans don't even flinch. With just a few quick clicks on her keyboard, electrophysiology technician Isabelle Bouchard, the only one in the whole hospital, sent the patient's heart the shock it needed to restart, and off it went again.

So, Bouchard has just saved the patient's life?

"Yes," answered Bérubé, calmly. Her eyes, above her mask, shine with pride.

The work is meticulous and the progress is incremental. Eventually, the team identifies the problem area that needs to be neutralized. Dr Hadjis begins to destroy the damaged tissue.

On Bouchard's screen, the difference is unmistakable: on the left, the electrocardiogram is a real squiggle, a sign that the heart is shaken by a tachycardia attack; on the right, immediately after Dr Hadjis' intervention, the tracing has returned to normal.

TRAINING AND SUPPORT

Dr. Hadjis is one of the only Canadian doctors trained to correct ventricular tachycardia, and he travels the country.

He recently went to Newfoundland to perform a procedure — a long trip for a four- or five-hour procedure, which represents a more or less optimal use of his time.

Abbott's capture at Sacré-Coeur should facilitate the training of new specialists, in Canada and around the world, by enabling them to virtually enter the hospital's electrophysiology laboratory. All they have to do is don a virtual reality headset to see everything Dr. Hadjis and his team saw during the recording, and especially to learn the ablation technique they use to regulate ventricular tachycardia.

"Eventually, we hope to develop the program so that I can help my colleagues at sites a little further away," said Dr. Hadjis.

In the electrophysiology laboratory, the procedure is drawing to a close. Everything went so well that the team, after a quick consultation, decided to operate on a second patient, a 70-year-old man, in the afternoon. The patient had come to the hospital and had been waiting — and fasting — since morning, crossing his fingers that a place would be found for him.

His patience is about to be rewarded.

This report by The Canadian Press was first published in French on July 27, 2023.