Impact of three-dimensional imaging and printing on septal myectomy results-single centre's experience

Abstract

Objectives: To assess changes in the results of septal myectomy (SM) following introduction of three-dimensional (3D) imaging and 3D printing in surgical interventions planning and performing in the single-centre settings.

Methods: Between January 2007 and March 2022, 268 consecutive symptomatic patients with hypertrophic obstructive cardiomyopathy and peak pressure gradient at obstruction area ≥50 mmHg underwent conventional SM (n = 112) or SM with heart 3D modelling (n = 156).

Results: For comparative analysis, we used propensity score matching (PSM) by 14 variables and there were formed group 1PSM (conventional SM, n = 77) and group 2PSM (3D-modelled SM, n = 77). It was noted for group 2PSM: larger mean resected myocardium mass [10.0 (standard deviation 4.3) vs 5.2 (standard deviation 2.7) g], P < 0.001, no mitral valve replacement cases [0 vs 28 (36.4%), P < 0.001], no iatrogenic ventricular septal defects cases [0 vs 6 (7.8%), P = 0.028], lower rate of major complications [6 (7.8%) vs 17 (22.1%), P = 0.011], smaller residual peak systolic gradient at the obstruction level [7.0 (5.0-9.0) vs 11.0 (7.0-16.0) mmHg, P < 0.001]. During the long-term follow-up, it was noted for group 2PSM as compared to group 1PSM: lower 5-year cumulative incidence of major adverse cardiovascular events [3.8% (95% confidence interval 0.7-11.7%) vs 16.9% (9.5-26.1%), P = 0.007] and cardiac-related death [3.8% (95% confidence interval 0.7-11.7%) vs 13% (95% confidence interval 6.6-21.6%), P = 0.05].

Conclusions: SM based on 3D virtual and printed heart models is more effective than conventional SM.

Keywords: 3D imaging; 3D printing; Hypertrophic obstructive cardiomyopathy; Septal myectomy.

Graphical abstract

Figure 1:

(A) 3D models of the interventricular septum with abnormal muscle bundles after virtual septal myectomy. (B) 3D models of the interventricular septum for septal myectomy planning, first surgeon view. 3D: three-dimensional; IVS: interventricular septum; LCA: left coronary artery; LVOT: left ventricular outflow tract; RCA: right coronary artery; VSM: virtual septal myectomy.

Figure 2:

Surgery steps: (A) using 3D-printed model in measuring myocardial resection depth and width and (B) weighing of resected myocardium. 3D: three-dimensional.