Three-dimensional printing-guided percutaneous transcatheter replacement in coarctation of the aorta: a retrospective study

Abstract

Background: To evaluate the feasibility, effectiveness and assistant effect of 3D printed aortic model in the treatment on congenital coarctation of the aorta (CoA) in adolescents and adults.

Methods: From December 2018 to December 2023, a total of 10 patients with congenital coarctation of aorta underwent percutaneous balloon dilatation covered stent implantation in the department of cardiovascular surgery, Xijing Hospital. There were 6 males and 4 females whose average age was (27.68 ± 13.45) years. One case complicated with ventricular septal defect (VSD). The CT data of aorta were collected before operation, and the aorta was reconstructed by Mimics software and printed with 3D printing technology. The operation simulation was performed before operation to determine the best operation plan. The clinical data during hospitalization and follow-up were analyzed.

Results: All the patients of CoA were successfully treated with percutaneous balloon dilatation covered stent implantation. The narrowest average diameter of CoA increased from (4.35 ± 2.61) mm before operation to (16.84 ± 1.99) mm immediately after operation (P < 0.05). The mean transconstrictive systolic pressure difference decreased from (81.29 ± 18.72) mmHg before operation to (15.52 ± 7.47) mmHg after operation (P < 0.05). The mean systolic blood pressure of the right upper limb decreased from (182.05 ± 38.99) mmHg preoperatively to (141.95 ± 32.11) mmHg postoperatively (P < 0.05). The mean systolic blood pressure of the lower limb increased from (121.52 ± 27.84) mmHg preoperatively to (131.81 ± 32.39) mmHg postoperatively (P < 0.05). Two patients with PDA and VSD underwent interventional occlusion at the same time without shunt. During the period of hospitalization and follow-up, there were significant cardiovascular complications.

Conclusions: Percutaneous balloon dilatation covered stent implantation is effective in the treatment of adolescents and adults with CoA in the short and medium term, with fewer complications, and the long-term effect needs furthshdie1er study.

Keywords: 3D printing; coarctation of aorta; covered stent; interventional therapy; transcatheter replacement.

Figure 1

Protocal of the experiment.

Figure 2

Preoperative CTA reconstruction image of the patient. (A,B) CTA reconstruction imaging shows the location of aortic arch constriction; (C,D) Using computer reconstruction technology, segment the anatomical structure around aortic constriction and highlight the location of aortic constriction.

Figure 3

Preoperative CT image data reconstruction and 3D printing model of patients. (A–C) Display CTA images of the aorta in different sections; (D,E) Mimics software displays the location of active artery constriction at different angles after reconstruction; (F–H) segmentation, decoration, and reconstruction of images for subsequent 3D printing; (I,J) 3D printed aortic constriction model displayed on different sides.

Figure 4

Interventional simulation using 3D printed models. (A) 3D printed aortic constriction model; (B) Using a 3D printing model of aortic constriction to simulate balloon dilation in vitro; (C) 3D printed aortic constriction model and stent with covered membrane; (D) in vitro simulated stent release at aortic constriction; The position relationship and fit degree between the (E,F) bracket and the 3D printed model after its release.

Figure 5

DSA angiography shows the process of stent implantation. (A) The contrast catheter passes through the constriction of the aorta; (B) angiography shows the location and degree of aortic arch constriction; (C) changing the angle of imaging to show narrowing of the aortic arch; (D) feeding into the conveying system from the femoral artery; (E) the conveying system; (F–H) transports the bracket to the predetermined position, narrows the plane, and performs imaging at different angles to determine the release position; (I) balloon dilation and release of stent; (J) evacuate the conveying system; (K,L) angiography shows the position of the covered stent and evaluates the pressure difference after expansion.

Figure 6

CT image reconstruction and 3D printing model after aortic coarctation surgery. (A) Postoperative aortic CTA reconstruction imaging showed stent position; (B–D) CTA images were imported into Mimics software and displayed different sections; (E,F) reconstruction images after stent implantation; (G,H) reconstructed images were segmented and modified for subsequent 3D printing; (I,J) 3D printed models after stent implantation.

Figure 7

Diameter and pressure difference (B) at the narrowest point of arch constriction before and after surgery. (A) Diameter of CoA, n = 10, means ± SD, pre vs. post, P < 0.05; (B) pressure difference of CoA, n = 10, means ± SD, pre vs. post, P < 0.05.