Division of Pediatric Cardiac Surgery, Cardiac Sciences, Sheikh Khalifa Medical City, Abu Dhabi P.O. Box 51900, United Arab Emirates.
Department of Public Health, Semmelweis University, H-1085 Budapest, Hungary.
Biomolecules. 2021 Nov 16;11(11):1703. 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.
三维（3D）虚拟建模和打印技术推动了个体化医学和手术的发展。在先天性心脏病手术中，3D 虚拟模型和打印原型具有更好地理解复杂解剖结构、术前手术规划和模拟、改善多学科团队内部和与患者之间沟通的优势。我们报告了我们的单一中心团队学习经验，即了解 3D 打印模型在复杂先天性心脏病手术的术前规划中的可能临床获益的实现和验证。将 CT 血管造影原始数据分割成心脏-大血管的 3D 虚拟模型。原型通过刚性“血液体积”和柔性“空心”进行 3D 打印。术中评估模型的准确性。生产步骤在临床/研究合作框架内实现。我们为 15 例复杂心脏内修复手术的病例（9 名男性，中位年龄：11 个月）制作了心脏-大血管的 3D 原型。3D 模型与术中结构之间的一致性在 1 毫米范围内。模型在 13/15 例中改善了诊断，在 9/15 例中提供了新的解剖信息。作为团队学习经验，所有复杂的分期再手术（13/15；亚里士多德评分平均值：10.64±1.95）均在术前通过 3D 模型进行预演。3D 打印原型在手术入路、13/15 例心脏内修复的修改方面显著有助于改进/替代手术计划。没有手术发病率/死亡率。我们的临床/研究合作关系涵盖了保险公司未支付的额外时间/劳动力、材料/机器费用。3D 打印模型为团队学习提供了经验，并为复杂先天性心脏病手术的安全性做出了贡献。临床/研究合作关系可能为患者特异性植入物的生物打印开辟途径。
