Three-Dimensional Virtual and Printed Prototypes in Complex Congenital and Pediatric Cardiac Surgery—A Multidisciplinary Team-Learning Experience

• Published in: Biomolecules (Basel, Switzerland) Vol. 11; no. 11; p. 1703
• Main Authors: Kiraly, Laszlo, Shah, Nishant C., Abdullah, Osama, Al-Ketan, Oraib, Rowshan, Reza
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 16.11.2021; MDPI
• Subjects: 3-D printers; Angiography; Blood; Cardiac Surgical Procedures - education; Cardiac Surgical Procedures - methods; Child; Child, Preschool; congenital heart disease; congenital heart surgery; Coronary vessels; Emulation; Female; hands-on surgical training; Heart; Heart Defects, Congenital - diagnostic imaging; Heart Defects, Congenital - surgery; Heart surgery; Humans; Imaging, Three-Dimensional; Infant; Learning; Male; Manufacturing; Models, Anatomic; Morbidity; Multidisciplinary teams; Patient Care Team; Patients; Pediatrics; Physical properties; Planning; Printing, Three-Dimensional; Questionnaires; Surgery; surgical simulation; surgical training; three-dimensional printing; Veins & arteries; Belgium; United States > US; congenital heart disease; surgical training; hands-on surgical training; congenital heart surgery; surgical simulation; three-dimensional printing
• ISSN: 2218-273X; 2218-273X
• DOI: 10.3390/biom11111703

Three-dimensional (3D) virtual modeling and printing advances individualized medicine and surgery. In congenital cardiac surgery, 3D virtual models and printed prototypes offer advantages of better understanding of complex anatomy, hands-on preoperative surgical planning and emulation, and improved communication within the multidisciplinary team and to patients. We report our single center team-learning experience about the realization and validation of possible clinical benefits of 3D-printed models in surgical planning of complex congenital cardiac surgery. CT-angiography raw data were segmented into 3D-virtual models of the heart-great vessels. Prototypes were 3D-printed as rigid “blood-volume” and flexible “hollow”. The accuracy of the models was evaluated intraoperatively. Production steps were realized in the framework of a clinical/research partnership. We produced 3D prototypes of the heart-great vessels for 15 case scenarios (nine males, median age: 11 months) undergoing complex intracardiac repairs. Parity between 3D models and intraoperative structures was within 1 mm range. Models refined diagnostics in 13/15, provided new anatomic information in 9/15. As a team-learning experience, all complex staged redo-operations (13/15; Aristotle-score mean: 10.64 ± 1.95) were rehearsed on the 3D models preoperatively. 3D-printed prototypes significantly contributed to an improved/alternative operative plan on the surgical approach, modification of intracardiac repair in 13/15. No operative morbidity/mortality occurred. Our clinical/research partnership provided coverage for the extra time/labor and material/machinery not financed by insurance. 3D-printed models provided a team-learning experience and contributed to the safety of complex congenital cardiac surgeries. A clinical/research partnership may open avenues for bioprinting of patient-specific implants.