Table 1.

Studies assessing XR for surgical planning (excluding case series/reports with fewer than 5 patients)

First author	Year	Cohort	Lesion(s)	Pt no.	Control	XR type	Modality	Study description	Results
Sadeghi et al.[17]	2020	Adult	TV repair, Ao root/arch reconstruction, VAD extraction	6	N	VR	CT	Prospective case series Qualitative surgeon evaluation of VR system in procedure planning.	Perceived user-friendliness 4/5; usefulness and efficiency 4.4/5; attitude towards (future) use 4/5
Lu et al.[10]	2020	Paed.	AVV repair, VSD closure, DORV repair, TAPVD repair/revision, MAPCA unifocalisation, LSVC baffling to RA	25	N	MR	echo, CT, MRI	Prospective comparative study Qualitative surgeon feedback on prospective use of MR system for surgical planning compared to 2D screen	MR images reviewed for longer (8 vs. 3 min, p < 0 0.001) MR review “worthwhile” in 96% cases Improved anatomical understanding in 84% Surgical plan altered in 2 cases
Cen et al.[15]	2021	Paed.	PA + MAPCAs	5	N	VR/ MR	CT	Prospective case series - surgeon review of 3D print and VR of segmented model STL pre-operatively, intraoperative display of the model in MR and questionnaire	No mortality. 3 complications - prolonged pleural drainage, ST changes and pneumonia. Surgeons reported subjective benefit of all 3D modelling modalities.
Tedoriya et al.[26]	2020	Adult	AoV repair	26	N	MR	CT	Prospective case series – review of CT imaging in VR prior to AoV repair	6/26 required additional procedure 1/26 required AVR 1/26 died 19/26 - good echocardiographic result
Vettukattil et al.[13]	2020	Paed.	TAPVD + AVSD (n = 4) ccTGA + PS PA/IVS + failing Fontan Univentricular + PAB	7	N	MR	CT	Prospective case series – MR review of imaging to determine feasibility for biventricular repair	Biventricular repair in 7/7, no mortality. 4/7 - uncomplicated recovery 2/7 – required ECMO 1/7 – AKI and Guillain-Barre. Clinical status at 11 months − 5/7 NYHA I, 1/7 NYHA II, 1/7 ongoing recovery from Guillain-Barre.
Ye et al.[9]	2021	Paed.	DORV	34	Y	MR	CT	Prospective randomised control study Patients allocated to pre-op imaging review on 2D screen (control) or standard + MR review imaging (intervention).	Surgical planning time reduced in MR group (52 ± 11 min vs. 66 ± 18 min; p < 0.05) Correct pre-op identification of anatomy in all MR cases, incorrect in 2 control group cases No change to pre-op plan in MR group, strategy modified in 3 control cases.
Gehrsitz et al.[8]	2021	Paed.	TOF, CoA, AP window, ALCAPA, TGA, PV disease, PA/VSD, truncus arteriosus, ccTGA, AVSD, ductus arteriosus aneurysm	26	Y	MR	CT, MRI	Prospective comparative study - surgeons completed structured questionnaires comparing 2D screen imaging review, MR, and 3D-printed model. Surgical preparation time compared with retrospectively matched controls.	MR rated better than 2D-monitor imaging + 3D prints in all categories. (mean 4.4/5 ± 1 vs. 3.7/5 ± 1.3, p < 0.05). 3D print + MR reduced intra-op preparation time (59 ± 23 min vs. 73 ± 43 min, P < 0.05).
Chan et al.[18]	2021	Paed.	Unifocalisation of MAPCAs, pulmonary artery reconstructions	17	N	MR	CT	Prospective case series – MR review of segmented CT models prior to surgery.	No system-related surgical complications Manual image processing time 2–4 h MR viewing time from 10–30 min
Pushparajah et al.[11]	2021	Paed.	AVV repair	15	N	VR	3DE	Retrospective – surgeon review of pre-op 3DE from previous AVV surgery. Review on 2D screen and in VR. Recommended surgical strategy recorded for 2D + VR review, compared to operation note	In 67% of cases, the surgeon reported that VR gave them more confidence in the anatomy and would have made modifications to surgical approach in over 57% of cases.
Milano et al.[12]	2019	Paed.	DORV	10	N	VR	CT, MRI	Retrospective – surgeons reviewed segmentations on 2D screen, 3D print, and in VR. Recommended suitability for biventricular repair and requirement for ASO	Surgical strategy correctly identified in 70% after 2D review, 85% after 3D print and 95% after VR visualisation. Correctly identified need for ASO in 45% with 2D review; 55% with 3D print and 60% after VR review

Paed. : paediatric, N: no, Y: yes

3DE: 3D echocardiography, AKI: acute kidney injury, ALCAPA: anomalous origin of the left coronary artery from the pulmonary artery, Ao: aorta, AP: aortopulmonary, AVSD: atrioventricular septal defect; AVR: aortic valve replacement, AVV: Atrioventricular valve, ccTGA: congenitally-corrected transposition of the great arteries, CoA: coarctation of the aorta, DORV: double outlet right ventricle, ECMO: extracorporeal membrane oxygenation, LSVC: left superior vena cava, MAPCA: major aortopulmonary collateral, PA: pulmonary atresia; PAB: pulmonary artery band, PV: pulmonary valve, RA: right atrium, TOF: tetralogy of Fallot, TV: tricuspid valve, VAD: ventricular assist device, VSD: ventricular septal defect