Three-dimensional modelling and three-dimensional printing in pediatric and congenital cardiac surgery

Abstract

Three-dimensional (3D) modelling and printing methods greatly support advances in individualized medicine and surgery. In pediatric and congenital cardiac surgery, personalized imaging and 3D modelling presents with a range of advantages, e.g., better understanding of complex anatomy, interactivity and hands-on approach, possibility for preoperative surgical planning and virtual surgery, ability to assess expected results, and improved communication within the multidisciplinary team and with patients.3D virtual and printed models often add important new anatomical findings and prompt alternative operative scenarios. For the lack of critical mass of evidence, controlled randomized trials, however, most of these general benefits remain anecdotal. For an individual surgical case-scenario, prior knowledge, preparedness and possibility of emulation are indispensable in raising patient-safety. It is advocated that added value of 3D printing in healthcare could be raised by establishment of a multidisciplinary centre of excellence (COE).Policymakers, research scientists, clinicians, as well as health care financers and local entrepreneurs should cooperate and communicate along a legal framework and established scientific guidelines for the clinical benefit of patients, and towards financial sustainability. It is expected that besides the proven utility of 3D printed patient-specific anatomical models, 3D printing will have a major role in pediatric and congenital cardiac surgery by providing individually customized implants and prostheses, especially in combination with evolving techniques of bioprinting.

The Role of 3D Printing in Medical Applications: A State of the Art

“…The additive manufacturing helps the surgeons to have more information than the only ones that imaging technologies can afford. It helps the surgeon in the spatial orientation inside the cavities of a small infant heart and in simulating the surgical approach and steps of the operation with high fidelity [79]. This leads to shorter intraoperative time that per se has significant impact on complication rate, blood loss, postoperative length-of-stay, and reduced costs [80].…”

Personalized Three-Dimensional Printed Models in Congenital Heart Disease

“…Currently, no guidelines or recommendations are available regarding the standardized use of 3D printed models in CHD patients. Use of 3D printed models is limited to complex CHD such as DORV (Figure 10) and ToF as evidenced by anecdotal reports and case series [16,21,22,23,31,32,33,56,57]. Other clinical benefits of using 3D printed heart models such as its impact on procedural safety and long-term outcomes are still yet to be investigated.…”

Three-Dimensional Printing: is it useful for Cardiac Surgery?

“…Perhaps more challenging than determining the true incidence of CHD is addressing the unique nature of each case and determining the most efficient ways to train surgeons and plan each surgery. One complicating factor is that each patient’s anatomy can change the choice of surgical method, but this anatomy may not be fully understood until the time of surgery [ 9 , 10 ] .…”