{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T22:53:50Z","timestamp":1776207230462,"version":"3.50.1"},"reference-count":23,"publisher":"Springer Science and Business Media LLC","issue":"5","license":[{"start":{"date-parts":[[2021,6,7]],"date-time":"2021-06-07T00:00:00Z","timestamp":1623024000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,6,7]],"date-time":"2021-06-07T00:00:00Z","timestamp":1623024000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100009396","name":"Universit\u00e4tsSpital Z\u00fcrich","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100009396","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003006","name":"ETH Zurich","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100003006","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Cardiovasc Eng Tech"],"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The increase in cardiovascular disease cases that require minimally invasive treatment is inducing a new need to train physicians to perform them safely and effectively. Nevertheless, adaptation to simulation-based training has been slow, especially for complex procedures.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>We describe a newly developed mitral valve repair (MVR) simulator, equipped with new objective performance assessment methods, with an emphasis on its use for training the MitraClip\u2122 procedure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The MVR contains phantoms of all anatomical structures encountered during mitral valve repair with a transvenous, transseptal approach. In addition, several cameras, line lasers, and ultraviolet lights are used to mimic echocardiographic and fluoroscopic imaging and with a remote eye tracker the cognitive behaviour of the operator is recorded. A pilot study with a total of 9 interventional cardiologists, cardiac surgeons and technical experts was conducted. All participants performed the MitraClip procedure on the MVR simulator using standard interventional tools. Subsequently, each participant completed a structured questionnaire to assess the simulator.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The simulator functioned well, and the implemented objective performance assessment methods worked reliably. Key performance metrics such as x-ray usage were comparable with results from studies assessing these metrics in real interventions. Fluoroscopy imaging is realistic for the transseptal puncture but reaches its limits during the final steps of the procedure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The functionality and objective performance assessment of the MVR simulator were demonstrated. Especially for complex procedures such as the MitraClip procedure, this simulator offers a suitable platform for risk-free training and education.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s13239-021-00549-4","type":"journal-article","created":{"date-parts":[[2021,6,7]],"date-time":"2021-06-07T19:03:08Z","timestamp":1623092588000},"page":"530-538","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Transcatheter Mitral Valve Repair Simulator Equipped with Eye Tracking Based Performance Assessment Capabilities: A Pilot Study"],"prefix":"10.1007","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1329-3469","authenticated-orcid":false,"given":"Jan Michael","family":"Zimmermann","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mattia","family":"Arduini","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luca","family":"Vicentini","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesco","family":"Maisano","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mirko","family":"Meboldt","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,6,7]]},"reference":[{"key":"549_CR1","doi-asserted-by":"publisher","first-page":"350","DOI":"10.9738\/INTSURG-D-14-00004.1","volume":"100","author":"RA Agha","year":"2015","unstructured":"Agha, R. A., and A. J. Fowler. The role and validity of surgical simulation. Int. Surg. 100:350\u2013357, 2015.","journal-title":"Int. Surg."},{"key":"549_CR2","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1186\/s10397-017-1020-6","volume":"14","author":"A Alsalamah","year":"2017","unstructured":"Alsalamah, A., R. Campo, V. Tanos, G. Grimbizis, Y. Van Belle, K. Hood, N. Pugh, and N. Amso. Face and content validity of the virtual reality simulator \u2018ScanTrainer\u00ae\u2019. Gynecol. Surg. 14:18, 2017.","journal-title":"Gynecol. Surg."},{"key":"549_CR3","doi-asserted-by":"publisher","first-page":"86","DOI":"10.1111\/medu.13652","volume":"53","author":"JR Boulet","year":"2019","unstructured":"Boulet, J. R., and S. J. Durning. What we measure \u2026 and what we should measure in medical education. Med. Educ. 53:86\u201394, 2019.","journal-title":"Med. Educ."},{"key":"549_CR4","doi-asserted-by":"publisher","first-page":"1342","DOI":"10.1016\/j.jcin.2019.02.039","volume":"12","author":"AK Chhatriwalla","year":"2019","unstructured":"Chhatriwalla, A. K., S. Vemulapalli, D. R. Holmes, D. Dai, Z. Li, G. Ailawadi, D. Glower, S. Kar, M. J. Mack, J. Rymer, A. S. Kosinski, and P. Sorajja. Institutional experience with transcatheter mitral valve repair and clinical outcomes. JACC Cardiovasc. Interv. 12:1342\u20131352, 2019.","journal-title":"JACC Cardiovasc. Interv."},{"key":"549_CR5","doi-asserted-by":"crossref","unstructured":"Gong, R.H., B. Jenkins, R.W. Sze, Z. Yaniv. A cost effective and high fidelity fluoroscopy simulator using the Image-Guided Surgery Toolkit (IGSTK), 2014, vol. 903618, p. 903618.","DOI":"10.1117\/12.2044112"},{"key":"549_CR6","doi-asserted-by":"publisher","first-page":"717","DOI":"10.1097\/00002060-200110000-00001","volume":"80","author":"EW Johnson","year":"2001","unstructured":"Johnson, E. W. Visual analog scale (VAS). Am. J. Phys. Med. Rehabil. 80:717, 2001.","journal-title":"Am. J. Phys. Med. Rehabil."},{"key":"549_CR7","doi-asserted-by":"publisher","first-page":"396","DOI":"10.9734\/BJAST\/2015\/14975","volume":"7","author":"A Joshi","year":"2015","unstructured":"Joshi, A., S. Kale, S. Chandel, and D. Pal. Likert scale: explored and explained. Br. J. Appl. Sci. Technol. 7:396\u2013403, 2015.","journal-title":"Br. J. Appl. Sci. Technol."},{"key":"549_CR8","doi-asserted-by":"crossref","unstructured":"Larnpotang, S., D. Lizdas, D. Rajon, I. Luria, N. Gravenstein, Y. Bisht, W. Schwab, W. Friedman, F. Bova, A. Robinson. Mixed simulators: augmented physical simulators with virtual underlays. Proceedings of the IEEE Virtual Reality, 2013, pp 7\u201310.","DOI":"10.1109\/VR.2013.6549348"},{"key":"549_CR9","doi-asserted-by":"publisher","first-page":"192","DOI":"10.1016\/j.jacr.2009.11.010","volume":"7","author":"BE Lehnert","year":"2010","unstructured":"Lehnert, B. E., and R. L. Bree. Analysis of appropriateness of outpatient CT and MRI referred from primary care clinics at an academic medical center: how critical is the need for improved decision support? J. Am. Coll. Radiol. 7:192\u2013197, 2010.","journal-title":"J. Am. Coll. Radiol."},{"key":"549_CR10","first-page":"273","volume":"84","author":"JA Martin","year":"1997","unstructured":"Martin, J. A., G. Regehr, R. Reznick, H. Macrae, J. Murnaghan, C. Hutchison, and M. Brown. Objective structured assessment of technical skill (OSATS) for surgical residents. Br. J. Surg. 84:273\u2013278, 1997.","journal-title":"Br. J. Surg."},{"key":"549_CR11","doi-asserted-by":"publisher","first-page":"244","DOI":"10.1089\/end.2007.9985","volume":"21","author":"EM McDougall","year":"2007","unstructured":"McDougall, E. M. Validation of surgical simulators. J. Endourol. 21:244\u2013247, 2007.","journal-title":"J. Endourol."},{"key":"549_CR12","doi-asserted-by":"publisher","first-page":"824","DOI":"10.1016\/j.jtcvs.2017.09.135","volume":"155","author":"S Moffatt-Bruce","year":"2018","unstructured":"Moffatt-Bruce, S., J. Crestanello, D. P. Way, and T. E. Williams. Providing cardiothoracic services in 2035: signs of trouble ahead. J. Thorac. Cardiovasc. Surg. 155:824\u2013829, 2018.","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"549_CR13","unstructured":"Stanford Children\u2019s Health. The Stanford Virtual Heart\u2014Revolutionizing Education on Congenital Heart Defects n.d. https:\/\/www.stanfordchildrens.org\/en\/innovation\/virtual-reality\/stanford-virtual-heart. Accessed 9 Mar 2021."},{"key":"549_CR14","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1111\/j.1526-4610.2008.01272.x","volume":"48","author":"SJ Tepper","year":"2008","unstructured":"Tepper, S. J. Computed tomography\u2014an increasing source of radiation exposure: commentary. Headache 48:657, 2008.","journal-title":"Headache"},{"key":"549_CR15","unstructured":"Tobii Technology. Pro Nano User Manual n.d. https:\/\/www.tobiipro.com\/siteassets\/tobii-pro\/user-manuals\/tobii-pro-nano-user-manual.pdf\/?v=2.0. Accessed 8 Mar 2021."},{"key":"549_CR16","unstructured":"University Hospital Zurich. CAS\u2014Mitral and Tricuspid Valve Structural Interventions n.d. https:\/\/usz-microsite.ch\/mitral-and-tricuspid-valve-structural-interventions\/. Accessed 2 Apr 2020."},{"key":"549_CR17","doi-asserted-by":"publisher","first-page":"622","DOI":"10.1016\/j.surg.2009.10.068","volume":"147","author":"SS Van Nortwick","year":"2010","unstructured":"Van Nortwick, S. S., T. S. Lendvay, A. R. Jensen, A. S. Wright, K. D. Horvath, and S. Kim. Methodologies for establishing validity in surgical simulation studies. Surgery 147:622\u2013630, 2010.","journal-title":"Surgery"},{"key":"549_CR18","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2017\/2707690","volume":"2017","author":"M Varoquier","year":"2017","unstructured":"Varoquier, M., C. P. Hoffmann, C. Perrenot, N. Tran, and C. Parietti-Winkler. Construct, face, and content validation on voxel-man\u00ae simulator for otologic surgical training. Int. J. Otolaryngol. 2017:1\u20138, 2017.","journal-title":"Int. J. Otolaryngol."},{"key":"549_CR19","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1016\/j.jsurg.2013.08.010","volume":"71","author":"V Waran","year":"2014","unstructured":"Waran, V., V. Narayanan, R. Karuppiah, D. Pancharatnam, H. Chandran, R. Raman, Z. A. A. Rahman, S. L. F. Owen, and T. Z. Aziz. Injecting realism in surgical training\u2014initial simulation experience with custom 3D models. J. Surg. Educ. 71:193\u2013197, 2014.","journal-title":"J. Surg. Educ."},{"key":"549_CR20","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1016\/S1479-666X(07)80058-8","volume":"5","author":"D West","year":"2007","unstructured":"West, D., M. Codispoti, and T. Graham. The European Working Time Directive and training in cardiothoracic surgery in the United Kingdom. The Surgeon 5:81\u201385, 2007.","journal-title":"The Surgeon"},{"key":"549_CR21","unstructured":"World Health Organization (WHO). Cardiovascular diseases (CVDs) 2017. https:\/\/www.who.int\/en\/news-room\/fact-sheets\/detail\/cardiovascular-diseases-(cvds). Accessed 30 Mar 2020."},{"issue":"6","key":"549_CR22","doi-asserted-by":"publisher","first-page":"1202","DOI":"10.1002\/ccd.28493","volume":"95","author":"JM Zimmermann","year":"2019","unstructured":"Zimmermann, J. M., O. J. Steffen, L. Vicentini, M. Schmid Daners, M. Taramasso, F. Maisano, and M. Meboldt. Novel augmented physical simulator for the training of transcatheter cardiovascular interventions. Catheter. Cardiovasc. Interv. 95(6):1202\u20131209, 2019.","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"549_CR23","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1097\/RLI.0000000000000658","volume":"55","author":"JM Zimmermann","year":"2020","unstructured":"Zimmermann, J. M., L. Vicentini, D. Van Story, A. Pozzoli, M. Taramasso, Q. Lohmeyer, F. Maisano, and M. Meboldt. Quantification of avoidable radiation exposure in interventional fluoroscopy with eye tracking technology. Investig. Radiol. 55:457\u2013462, 2020.","journal-title":"Investig. Radiol."}],"container-title":["Cardiovascular Engineering and Technology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s13239-021-00549-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s13239-021-00549-4\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s13239-021-00549-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,4]],"date-time":"2023-11-04T16:51:32Z","timestamp":1699116692000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s13239-021-00549-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6,7]]},"references-count":23,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2021,10]]}},"alternative-id":["549"],"URL":"https:\/\/doi.org\/10.1007\/s13239-021-00549-4","relation":{},"ISSN":["1869-408X","1869-4098"],"issn-type":[{"value":"1869-408X","type":"print"},{"value":"1869-4098","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,6,7]]},"assertion":[{"value":"16 December 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 May 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 June 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}}]}}