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

Boll, Liliana Fortini Cavalheiro; Rodrigues, Guilherme Oberto; Rodrigues, Clarissa Garcia; Bertollo, Felipe Luiz; Irigoyen, Maria Claudia; Goldmeier, Silvia

doi:10.1590/1806-9282.65.6.818

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Original Article • Rev. Assoc. Med. Bras. 65 (6) • June 2019 • https://doi.org/10.1590/1806-9282.65.6.818 linkcopy

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

Authorship SCIMAGO INSTITUTIONS RANKINGS

BACKGROUND: The use of the 3D printer in complex cardiac surgery planning.

OBJECTIVES: To analyze the use and benefits of 3D printing in heart valve surgery through a systematic review of the literature.

METHODS: This systematic review was reported following the Preferred Reporting Items for Systematic Review and registered in the Prospero (International Prospective Register of Systematic Reviews) database under the number CRD42017059034. We used the following databases: PubMed, EMBASE, Scopus, Web of Science and Lilacs. We included articles about the keywords “Heart Valves”, “Heart Valve Prosthesis Implantation”, “Heart Valve Prosthesis”, “Printing, Three-Dimensional”, and related entry terms. Two reviewers independently conducted data extraction and a third reviewer solved disagreements. All tables used for data extraction are available at a separate website. We used the Cochrane Collaboration tool to assess the risk of bias of the studies included.

RESULTS: We identified 301 articles and 13 case reports and case series that met the inclusion criteria. Our studies included 34 patients aged from 3 months to 94 years.

CONCLUSIONS: Up to the present time, there are no studies including a considerable number of patients. A 3D-printed model produced based on the patient enables the surgeon to plan the surgical procedure and choose the best material, size, format, and thickness to be used. This planning leads to reduced surgery time, exposure, and consequently, lower risk of infection.

KEYWORDS:
Heart Valves; Printing; Three-Dimensional; Cardiovascular Surgical Procedures

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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