A Systematic Analysis of Additive Manufacturing Techniques in the Bioengineering of In Vitro Cardiovascular Models

Abstract

Additive Manufacturing is noted for ease of product customization and short production run cost-effectiveness. As our global population approaches 8 billion, additive manufacturing has a future in maintaining and improving average human life expectancy for the same reasons that it has advantaged general manufacturing. In recent years, additive manufacturing has been applied to tissue engineering, regenerative medicine, and drug delivery. Additive Manufacturing combined with tissue engineering and biocompatibility studies offers future opportunities for various complex cardiovascular implants and surgeries. This paper is a comprehensive overview of current technological advancements in additive manufacturing with potential for cardiovascular application. The current limitations and prospects of the technology for cardiovascular applications are explored and evaluated.

Keywords: Additive manufacturing; Cardiovascular applications; Congenital heart disease; Heart models; Stents.

Fig. 1

The board range of applications of additive manufacturing in cardiovascular has been divided into SIX major categories in this study

Fig. 2

3D model accuracy evaluation of Ventricular Septal Defect (VSD). a Coronal and Sagittal views of CT Imaging Data. b Measurement of the VSD in the 3D printed model using a digital caliper. c STL file measurement of the VSD in 3-Matic. The 3D model assessment shows the correlation measurement of VSD on CT image, 3D Model, and STL file. The study shows that the measurements of the 3D models have a strong correlation (r = 0.99) and excellent reliability (Intraclass correlation coefficient = 0.97) compared to the original CT images, CT images of the 3D printed models, STL files, and 3D printed congenital heart disease models [25].

Fig. 3

3D printed models generated from cardiac CT images which shows the Aortic Aneurysm structure from different angles. a Model shows the aortic aneurysm in relation to the three arterial branches starting from the aortic arch, namely left subclavian artery, left common carotid artery and innominate artery (arrow). b Lateral view showing the aneurysm. c Anterior view with artifact (arrow) in the aortic arch due to image post-processing. d Caudocranial view of aortic dissection showing intimal flap (arrows) [28].

Fig. 4

3D printing models lets the progress of precise life-like educational tools to demonstrate complex cardiovascular anatomy and pathology. a, b SLA transparent full heart model (normal anatomy) c, d Fused Deposition models illustrating standard transthoracic echocardiographic 2-Dimensional views (c apical four chamber view; d parasternal long axis) [61]

Fig. 5

3D printing of Mitral Value geometry with regional calcium deposition (yellow) and Pathology shown in model E in the above figure. a CT Image b Digital patient-specific model c Digital patient-specific valve leaflets with perforation d 3D printed model e Physical leaflet model with perforation [84]

Fig. 6

Illustrates the experimental design of In vivo implantation of vascular patches using standard grafts (SG) or 3D templated vascular grafts (3DT) using rat abdominal aorta model a–c White arrows indicate abdominal aorta; d red arrow indicates clamp; e green arrow indicates suture with SG or 3DT vascular patch; f yellow arrow indicates implanted SG or 3DT vascular patch; g, h the wound was closed layer by layer; i experimental design [101]