Dimensional Accuracy and Clinical Value of 3D Printed Models in Congenital Heart Disease: A Systematic Review and Meta-Analysis

Abstract

The aim of this paper is to summarize and evaluate results from existing studies on accuracy and clinical value of three-dimensional printed heart models (3DPHM) for determining whether 3D printing can significantly improve on how the congenital heart disease (CHD) is managed in current clinical practice. Proquest, Google Scholar, Scopus, PubMed, and Medline were searched for relevant studies until April 2019. Two independent reviewers performed manual data extraction and assessed the risk of bias of the studies using the tools published on National Institutes of Health (NIH) website. The following data were extracted from the studies: author, year of publication, study design, imaging modality, segmentation software, utility of 3DPHM, CHD types, and dimensional accuracy. R software was used for the meta-analysis. Twenty-four articles met the inclusion criteria and were included in the systematic review. However, only 7 studies met the statistical requirements and were eligible for meta-analysis. Cochran’s Q test demonstrated significant variation among the studies for both of the meta-analyses of accuracy of 3DPHM and the utility of 3DPHM in medical education. Analysis of all included studies reported the mean deviation between the 3DPHM and the medical images is not significant, implying that 3DPHM are highly accurate. As for the utility of the 3DPHM, it is reported in all relevant studies that the 3DPHM improve the learning experience and satisfaction among the users, and play a critical role in facilitating surgical planning of complex CHD cases. 3DPHM have the potential to enhance communication in medical practice, however their clinical value remains debatable. More studies are required to yield a more meaningful meta-analysis.

3D printed models of congenital heart disease: How accurate and how useful are they?

“…[1][2][3] However, in the domain of cardiovascular specialties, this technology is still considered fairly new. 4 The conventional way to interpret the medical images from twodimensional (2D) flat screen lacks comprehensiveness, hence tangible 3D printed heart models (3DPHM) were created to improve the users' perception on the depth information of the cardiac anatomies. [3][4][5][6] Although there are increasing reports on the use of 3DPHM, most of them remain anecdotal, and very few of them perform quantitative measurements of the accuracy and clinical value of the 3DPHM.…”

“…A total of 24 articles were included in the systematic review and 7 of them were used in the meta-analysis. 4 Based on the findings of this review, there are 4 different imaging modalities that can be used to generate 3DPHM, with computed tomography angiography (CTA) being the dominant, followed by cardiac magnetic resonance (CMR), echocardiography, and rotational angiography. Materialise Mimics is the most popular software for cardiac image segmentation, with 12 out of 24 studies (50 per cent) reporting its application.…”

“…Materialise Mimics is the most popular software for cardiac image segmentation, with 12 out of 24 studies (50 per cent) reporting its application. 4 It was found that the accuracy of the 3DPHM is reported in relatively few studies since only 7 out of 24 provided the statistical measurements of the 3DPHM. Nevertheless, all of these studies shared the same findings: 3DPHM is highly accurate.…”

“…This however, needs to be interpreted with care as the Cochran's Q test demonstrates high heterogeneity among the studies (p=0.0468). 4 It is also important to note that the quantitative synthesis of 3DPHM accuracy did not take into account the 3D printing technique and segmentation software used in the individual studies, which could also explain the significant heterogeneity among the studies.…”

“…In terms of the uses of 3DPHM, the most reported use of 3DPHM is its role in facilitating pre-operative planning, followed by medical education, communication, pre-surgical simulation, and intra-operative orientation. 4 Meta-analysis is only possible for 4 out of 12 studies which reported the use of 3DPHM in medical education. It was found that the 3DPHM group scored less in the test group compared to the control group, although it did not reach statistical significance (-0.43, 95 per cent CI (-4.75, 3.88), p=0.844) ( Figure 2).…”