Using a 3D printer in cardiac valve surgery: a systematic review

Autoria SCIMAGO INSTITUTIONS RANKINGS

INTRODUÇÃO: A impressora 3D é utilizada como coadjuvante no planejamento de cirurgias de cardiopatias complexas.

OBJETIVOS: Analisar o uso e os benefícios da impressão 3D em cirurgias de válvula cardíaca por meio de revisão sistemática da literatura.

MÉTODOS: Esta revisão sistemática foi conduzida de acordo com os itens do Preferred Reporting for Systematic Reviews e registrada no banco de dados Prospero (Registro Prospectivo Internacional de Revisão Sistemática) sob o número CRD42017059034. Foram utilizados os seguintes bancos de dados: PubMed, Embase, Scopus, Web of Science e Lilacs. Incluídos artigos com os termos de busca “Heart Valves”, “Heart Valve Prosthesis Implantation”, “Heart Valve Prosthesis”, “Printing, Three-Dimensional” e termos relacionados. Dois revisores independentes conduziram a extração dos dados e um terceiro (revisor) solucionou as discordâncias. Todas as tabelas usadas para a extração de dados estão disponibilizadas em site próprio. A ferramenta Cochraine Collaboration foi utilizada para avaliar o risco de viés na inclusão de estudos.

RESULTADOS: Identificados 301 artigos e 13 relatos de casos e séries de casos que atenderam aos critérios de inclusão. A amostra envolveu 34 pacientes, com idade de 3 meses a 94 anos.

CONCLUSÃO: Até o presente momento, não há estudos que contemplem um número considerável de pacientes. A impressão de um modelo 3D produzida a partir do protótipo do paciente permitirá ao cirurgião planejar a cirurgia, bem como escolher o melhor material, tamanho, formato e espessura da válvula a ser utilizada. Esse planejamento reduz o tempo de cirurgia, a exposição e, consequentemente, a redução do risco de infecção.

PALAVRAS-CHAVE:
Valvas cardíacas; Impressão tridimensional; Procedimentos cirúrgicos cardiovasculares

Study, Year	Country	Study design	Number of subjects	Age	Gender	Basic Diseases	Type of valve
Duan et al.¹¹/2013	USA	Case report	1	12	male	Congenital malformations	Aortic valve
Dankowski et al.¹²/2014	Poland	Case study	1	41	male	Dilated cardiomyopathy	Mitral valve
Little et al.¹³/2016	USA	Case report	1	62	male	Bacterial endocarditis	Mitral valve
Vukicevic et al.¹⁴/2017	USA	Case report	2			1-Mitral valve regurgitation 2- Tissue infection	Mitral valve
Gallo et al.¹⁵/2016	Italy	Case report	1	79		Hypertension, diabetes mellitus, chronic kidney disease, dyslipidemia, atrial fibrillation, epilepsy, thalassemia minor, and monoclonal gammopathy	Aortic valve
Maragiannis et al.¹⁶/2016	USA	Case report	8	84, 92, 94, 70, 91, 64, 81, 55	5- male 3- female	Severe degenerative aortic stenosis	6-Tricuspid and 2-Mitral valve
Sodian et al.¹⁷/2008	Germany	Case report	1	81	female	Aortic valve stenosis, after coronary artery bypass grafting (CABG)	Aortic valve
Bauch et al.¹⁸/2015	USA	Case report	2			Atrial fibrillation	Tricuspid valve
Schmauss et al.¹⁹/2015	Germany	Case report	8	16, 3m, 2, 14, 81, 43, 50, 70	4- female, 4- male	1-Congenital malformations 2- Congenital malformations 3- Congenital malformations 4- Congenital malformations 5- Aortic stenosis 6- Heart insufficiency 7- HIV, a type A Aortic dissection 8- Aortic valve stenosis, calcified ascending aorta	Aortic valve
Fujita et al.²⁰/2017	Japan	Case report	1	82	female	Previously undergone mitral valve replacement	Aortic valve
Jacobs et al.²¹/ 2008	Germany	Case report	3	50, 81, 50	2- female, 1- male	Malignant tumor and ventricular aneurysm	Mitral and Tricuspid valve
Kim et al.²²/ 2008	USA	Case report	4	30, 50, 72, 69	1- female, 3- male	Congenital VSD Atrial septal aneurysm Periprosthetic valvular defect. Thoracic aortic pseudoaneurysm	Aortic and Mitral valve
Hadeed et al.²³/ 2016	France	Case report	1	5m		Congenital malformations (systolic heart murmur)

Study, Year	Imaging Modality / Technique	Printer details	Manufacturing material	Endpoints of printers
Duan et al.¹¹/2013	Computed tomography	Micro-CT (GE eXplore CT120; GE Health Care, Milwaukee, WI) at 100 μm resolution, 80keV, 30 mA, 800 angles, 30 ms exposure time, 30 gain, and 20 offset.30	Alginate/gelatin hydrogel	Living aortic valve conduits with anatomical resemblance to the native valve based on alginate/gelatin hydrogel system
Dankowski et al.¹²/2014	Multi-slice computed tomography (MSCT)	3D printing as a clinically applicable heart modeling technology	Rubber-like urethane
Little et al.¹³/ 2016	Echocardiography and tomography	A multimaterial patient-specific 3D model	Multimaterial TangoPlus	Replicate the mitral valve leaflet geometry, regional calcium deposition (yellow) and pathology.
Vukicevic et al.¹⁴/2017	Clinical 3D transesophageal echocardiography and computed tomography	Multi-material 3D printing technology and addition 3D TEE	Multi-material, TangoPlus-Shore 3	Specific mitral leaflet geometry and the mitral valve apparatus can be digitally reconstructed from currently available clinical imaging tools
Gallo et al.¹⁵/2016	A 64-row multi-detector computed tomography (MDCT)	Three-dimensional (3D) model	Stereolithography	Was useful to rule out the risk of occlusion of the brachiocephalic trunk during the stent-valve deployment and is a useful tool to plan complex transcatheter
Maragiannis et al.¹⁶/2016	ECG-gated and 64-slice multi-detector CT	Multimaterial 3D printed	The rubber-like material TangoPlus	Replicate the anatomic and functional properties of severe degenerative aortic valve stenosis.
Sodian et al.¹⁷/2008	128-slice computed tomography	3D printing techniques	Stereolithographic model, Stereolithographic prototyping	Proving benefit in complex anatomy
Bauch et al.¹⁸/2015	Computed tomography (CT)64 slice	Three- dimensional (3D) printing technology	Poly-actic acid filament	Research to minimize detrimental interactions between permanent pacing leads(His) and the tricuspid valve apparatus
Schmauss et al.¹⁹/2015	CT 64 or 128 slices or MRI scans	3D printing models in collaboration with the Institute of Micro-Technology and Medical Device Technology,	A starch/cellulose powder (zp 15e) bound with polymer (zb 60). Using different types of material enables the production of rigid and flexible parts.	Perioperative planning and simulation in a variety of complex cases in pediatric and adult cardiac surgery
Fujita et al.²⁰/2017	Multislice computed tomography (MSCT)	3D reconstruction of computed tomography image.	Stereolithography	Simulation was performed using a patient-specific heart prototype to evaluate the safety and efficacy of TAVI guidewire use.
Jacobs et al.²¹/ 2008	Computer tomography (CT) and magnetic resonance imaging (MRI) images	3-dimensional (3D) printed multi-material	Plaster model	Planning and improved orientation to resection of ventricular aneurysm and malignant cardiac tumors may facilitate the surgical procedure due to better.
Kim et al.²²/ 2008	Multidetector CT	3D image processing software.	Polymerization of a photosensitive resin	Plan the operative approach for a 2.5-year-old child with single ventricle and single AV valve
Hadeed et al.²³/ 2016	Multi-detector-CT using 64-slice	Printed using a three-dimensional printer with HeartPrint® flex material (Materialise).	Flex material (Materialise)	Allows better understanding regard to size, position of ventricular septal defect, and its relationships with the great arteries.

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E-mail: ramb@amb.org.br

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