Abstract
Introduction: Computer-based simulation technologies, including virtual reality (VR), augmented reality (AR), mixed reality (MR), and three-dimensional (3D) modeling, are increasingly used in pediatric cardiovascular care. Despite growing adoption of these technologies, no comprehensive synthesis across VR, AR, MR, and 3D modeling modalities exists for pediatric cardiovascular care. Objective: This review aimed to synthesize evidence regarding the applications and outcomes of computer-based simulation technologies in pediatric cardiovascular diseases. Methods: A systematic review was conducted by searching nine databases (PubMed, Web of Science, Scopus, Ovid, the Cochrane Library, IEEE Xplore, ProQuest, CINAHL, and EBSCO Host) for eligible studies published up to 1 September 2025. Thirty-six studies were included and appraised using the Mixed Methods Appraisal Tool (MMAT), the Critical Appraisal Skills Programme (CASP) checklist, and the ROBINS-I tool. Substantial clinical and methodological heterogeneity precluded meta-analysis. Results: VR was the most frequently used modality (n = 14), followed by 3D modeling (n = 8), multimodal approaches (n = 8), MR (n = 6), and AR (n = 3). This technology was mainly used for congenital heart defects (n = 18). MR holography improved diagnostic accuracy for complex anomalies (95.5% vs. 89.7%); VR-based surgical plans aligned better with the real surgery than did 2D imaging plans (80% vs. 66%); VR was preferred over 3D-printed models by 87% of participants (8.5/10 vs. 6.3/10 for anatomical understanding); and VR curricula (Stanford Virtual Heart) significantly increased CHD knowledge scores among students and residents (p < 0.05). However, this evidence was predominantly derived from small, single-center observational studies, with barriers including hardware limitations and limited long-term outcome data. Conclusions: Computer-based simulation technologies show considerable potential for surgical planning, diagnostic assessment, and education in pediatric cardiovascular diseases. They can be used as complementary tools rather than replacements for standard imaging or clinical judgment. While VR and 3D modeling show promise for surgical planning and education, multicenter comparative studies with standardized outcomes and cost-effectiveness analyses are essential before routine clinical implementation.