Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Swiss MedTech Center, Switzerland Innovation Park Biel/Bienne AG, Switzerland.
Heart Lung Circ. 2022 Sep;31(9):1203-1218. doi: 10.1016/j.hlc.2022.04.052. Epub 2022 Jun 7.
To tailor cardiovascular interventions, the use of three-dimensional (3D), patient-specific phantoms (3DPSP) encompasses patient education, training, simulation, procedure planning, and outcome-prediction.
This systematic review and meta-analysis aims to investigate the current and future perspective of 3D printing for cardiovascular interventions.
We systematically screened articles on Medline and EMBASE reporting the prospective use of 3DPSP in cardiovascular interventions by using combined search terms. Studies that compared intervention time depending on 3DPSP utilisation were included into a meta-analysis.
We identified 107 studies that prospectively investigated a total of 814 3DPSP in cardiovascular interventions. Most common settings were congenital heart disease (CHD) (38 articles, 6 comparative studies), left atrial appendage (LAA) occlusion (11 articles, 5 comparative, 1 randomised controlled trial [RCT]), and aortic disease (10 articles). All authors described 3DPSP as helpful in assessing complex anatomic conditions, whereas poor tissue mimicry and the non-consideration of physiological properties were cited as limitations. Compared to controls, meta-analysis of six studies showed a significant reduction of intervention time in LAA occlusion (n=3 studies), and surgery due to CHD (n=3) if 3DPSPs were used (Cohen's d=0.54; 95% confidence interval 0.13 to 0.95; p=0.001), however heterogeneity across studies should be taken into account.
3DPSP are helpful to plan, train, and guide interventions in patients with complex cardiovascular anatomy. Benefits for patients include reduced intervention time with the potential for lower radiation exposure and shorter mechanical ventilation times. More evidence and RCTs including clinical endpoints are needed to warrant adoption of 3DPSP into routine clinical practice.
为了定制心血管介入治疗，使用三维（3D）、个体化模型（3DPSP）可以涵盖患者教育、培训、模拟、手术规划和结果预测。
本系统综述和荟萃分析旨在探讨 3D 打印在心血管介入治疗中的当前和未来前景。
我们系统地筛选了 Medline 和 EMBASE 上的文章，这些文章报告了 3DPSP 在心血管介入治疗中的前瞻性应用，使用了组合的搜索词。将比较基于 3DPSP 使用的介入时间的研究纳入荟萃分析。
我们确定了 107 项前瞻性研究，共涉及 814 例心血管介入治疗的 3DPSP。最常见的应用场景包括先天性心脏病（CHD）（38 篇文章，6 项比较研究）、左心耳（LAA）封堵（11 篇文章，5 项比较研究，1 项随机对照试验 [RCT]）和主动脉疾病（10 篇文章）。所有作者都描述了 3DPSP 在评估复杂解剖条件方面的帮助，而较差的组织模拟和不考虑生理特性被认为是其局限性。荟萃分析 6 项研究显示，在 LAA 封堵（n=3 项研究）和 CHD 手术（n=3 项研究）中，如果使用 3DPSP，干预时间显著减少（Cohen's d=0.54；95%置信区间 0.13 至 0.95；p=0.001），但应考虑到研究之间的异质性。
3DPSP 有助于规划、培训和指导复杂心血管解剖患者的介入治疗。患者受益包括减少介入时间，潜在降低辐射暴露和缩短机械通气时间。需要更多的证据和 RCT 包括临床终点来保证 3DPSP 被常规应用于临床实践。
