Use of 3D Printing in Preoperative Planning and Training for Aortic Endovascular Repair and Aortic Valve Disease

Abstract

Introduction: Three-dimensional (3D) printing has become an affordable tool for assisting heart surgeons in the aorta endovascular field, both in surgical planning, education and training of residents and students. This technique permits the construction of physical prototypes from conventional medical images by converting the anatomical information into computer aided design (CAD) files.

Objective: To present the 3D printing feature on developing prototypes leading to improved aortic endovascular surgical planning, as well as transcatheter aortic valve implantation, and mainly enabling training of the surgical procedure to be performed on patient's specific condition.

Methods: Six 3D printed real scale prototypes were built representing different aortic diseases, taken from real patients, to simulate the correction of the disease with endoprosthesis deployment.

Results: In the hybrid room, the 3D prototypes were examined under fluoroscopy, making it possible to obtain images that clearly delimited the walls of the aorta and its details. The endovascular simulation was then able to be performed, by correctly positioning the endoprosthesis, followed by its deployment.

Conclusion: The 3D printing allowed the construction of aortic diseases realistic prototypes, offering a 3D view from the two-dimensional image of computed tomography (CT) angiography, allowing better surgical planning and surgeon training in the specific case beforehand.

Fig. 1

Case 1: computed tomography (CT) angiography of penetrating aortic ulcer (PAU) on the thoracic aorta with a maximal diameter of 57mm. A) Oblique sagittal section on maximal diameter. B) Oblique sagittal section showing its relation to the great vessels. C) Reconstruction of the aneurysm.

Fig. 2

Computed tomography (CT) angiography of the 10 cm thoracic aortic aneurysm (An). A) Sagittal section. B) Oblique sagittal section at maximum diameter. C) Axial section at the level of the great vessels. D) Axial section at the level of the aortic arch.

Fig. 3

Case 3: computed tomography (CT) angiography identifying the anatomical features of the left ventricle outflow tract.

Fig. 4

Case 4: computed tomography (CT) angiography of abdominal aortic aneurysm (An). A) Digital reconstruction of the aneurysm. B) Axial section measuring the aneurysm, 67.2 mm in diameter.

Fig. 5

Case 5: computed tomography (CT) angiography of aortic dissection showing true lumen (TL) and false lumen (FL). A) Axial section on the level of the arch. B) Coronal section of the descending thoracic aorta. C) Sagittal section of the aortic arch.

Fig. 6

Case 6: computed tomography (CT) angiography of aortic dissection showing true lumen (TL) and false lumen (FL). A) Coronal section showing the dissection in the ascending aorta with its intimal tear. B) Axial section at the level of the intimal tear.

Fig. 7

Case 1: prototype printed on red polylactic acid (PLA). A) View from the front, showing the penetrating aortic ulcer in the arch. B) Prototype split, showing the inside view.

Fig. 8

Case 1: A) Fluoroscopy of the patient. B) Failure after deploying first endoprosthesis. C) After second endoprosthesis deployment on Zone 2. D) Fluoroscopy of the prototype. E) Simulation of endoprosthesis deployment on prototype. F) Prototype after endoprosthesis deployment.

Fig. 9

Case 2: prototype printed on red polylactic acid (PLA). A) Frontal view of the prototype. B) Rear view. C) Inside view.

Fig. 10

Case 2: fluoroscopy of the prototype. A) On zero degrees. B) 30° left. C) 60° left.

Fig. 11

Case 2: comparison between the prototype and the procedure. A) Fluoroscopy of the patient after procedure. B) Fluoroscopy of the prototype after procedure. C) Endoprosthesis inside prototype after deployment.

Video 1

Case 2: fluoroscopy of the prototype.

Video 2

Case 2: simulation of endoprosthesis deployment on prototype.

Fig. 12

Case 3: prototype. A) Printed on red polylactic acid (PLA). B) Printed on semitransparent resin. C) Fluoroscopy of the prototype.

Fig. 13

Case 4: prototype printed on semitransparent resin.

Video 3

Case 4: fluoroscopy of the prototype.

Fig. 14

Case 5: Prototype printed on red polylactic acid (PLA). A) Frontal view showing the false lumen. B) Prototype split, inside view showing the dissection. C) Prototype split with wire coming distally from true lumen to false lumen through the intimal tear.

Fig. 15

Case 6: Prototype printed on red polylactic acid (PLA). A) View from the front showing the extent of the false lumen. B) Prototype split showing the intimal tear.

Fig. 16

Case 5: simulation of endoprosthesis deployment on prototype. A) Fluoroscopy of the prototype. B) Simulation of endoprosthesis deployment on prototype. C) Prototype after endoprosthesis deployment.