3D printing for congenital heart disease: a single site’s initial three-yearexperience

Abstract

Background3D printing is an ideal manufacturing process for creating patient-matched models (anatomical models) for surgical and interventional planning. Cardiac anatomical models have been described in numerous case studies and journal publications. However, few studies attempt to describe wider impact of the novel planning augmentation tool. The work here presents the evolution of an institution’s first 3 full years of 3D prints following consistent integration of the technology into clinical workflow (2012–2014) - a center which produced 79 models for surgical planning (within that time frame). Patient outcomes and technology acceptance following implementation of 3D printing were reviewed.MethodsA retrospective analysis was designed to investigate the anatomical model’s impact on time-based surgical metrics. A contemporaneous cohort of standard-of-care pre-procedural planning (no anatomical models) was identified for comparative analysis. A post-surgery technology acceptance assessment was also employed in a smaller subset to measure perceived efficacy of the anatomical models. The data was examined.ResultsWithin the timeframe of the study, 928 primary-case cardiothoracic surgeries (encompassing both CHD and non-CHD surgeries) took place at the practicing pediatric hospital. One hundred sixty four anatomical models had been generated for various purposes. An inclusion criterion based on lesion type limited those with anatomic models to 33; there were 113 cases matching the same criterion that received no anatomical model. Time-based metrics such as case length-of-time showed a mean reduction in overall time for anatomical models. These reductions were not statistically significant. The technology acceptance survey did demonstrate strong perceived efficacy. Anecdotal vignettes further support the technology acceptance.Discussion & conclusionThe anatomical models demonstrate trends for reduced operating room and case length of time when compared with similar surgeries in the same time-period; in turn, these reductions could have significant impact on patient outcomes and operating room economics. While analysis did not yield robust statistical powering, strong Cohen’s d values suggest poor powering may be more related to sample size than non-ideal outcomes. The utility of planning with an anatomical model is further supported by the technology acceptance study which demonstrated that surgeons perceive the anatomical models to be an effective tool in surgical planning for a complex CHD repair. A prospective multi-center trial is currently in progress to further validate or reject these findings.

3D printing in medicine: current applications and future directions

“…Studies support the clinical value of 3D-printed models in CHD, specifically with reported usefulness of 3D printing in pre-surgical planning and simulation of complex situations (9,18,(23)(24)(25). Although most of the current literature on 3D printing in CHD is dominated by case reports and case series, emerging evidence based on randomized controlled trials and multicenter studies further confirms its incremental value over traditional visualization tools (26)(27)(28)(29)(30)(31).…”

A three-dimensional printed model in preoperative consent for ventricular septal defect repair

“…We only used pure white material to simply show the structure of the ventricular septal defect. Studies [22,23] have demonstrated color coding models may result in more intuitive representations. For example, blue and red rendering for veins and arteries, respectively, are often used in clinical medicine.…”

Tetralogy of Fallot Will be Treated Interventionally Within Two Decades

“…The utilization of 3D printing in interventional Cardiology is expending especially in the field of transcatheter pulmonary valve replacement. Use of 3D technology (including printing) has been shown for describing the vessels anatomy and guiding the surgical approach for intra-cardiac complex anatomy [18,19]. The 3D anatomical models showed a trend for reduced operating room time when compared with similar surgeries.…”