A personalized approach to interventional treatment of tricuspid regurgitation: experiences from an acute animal study

The Application of Precision Medicine in Structural Heart Diseases: A Step towards the Future

The personalized applications of 3D printing in interventional cardiology and cardiac surgery represent a transformative paradigm in the management of structural heart diseases. This review underscores the pivotal role of 3D printing in enhancing procedural precision, from preoperative planning to procedural simulation, particularly in valvular heart diseases, such as aortic stenosis and mitral regurgitation. The ability to create patient-specific models contributes significantly to predicting and preventing complications like paravalvular leakage, ensuring optimal device selection, and improving outcomes. Additionally, 3D printing extends its impact beyond valvular diseases to tricuspid regurgitation and non-valvular structural heart conditions. The comprehensive synthesis of the existing literature presented here emphasizes the promising trajectory of individualized approaches facilitated by 3D printing, promising a future where tailored interventions based on precise anatomical considerations become standard practice in cardiovascular care.

A Systematic Review of Individualized Heart Surgery with a Personalized Prosthesis

Personalized surgery is not just a new trend but rather a patient-specific approach to therapy that makes it possible to adopt a targeted approach for a specific patient and closely mirrors the approach of personalized medicine. However, the application of tailored surgery in the context of cardiovascular replacement surgery has not been systematically reviewed. The ability to customize a device is highly dependent on the collection of radiological image data for precise prosthesis modeling. These facts are essential to "tailor-made" device design for precise prosthesis implantation. According to this study, computed tomography (CT) was the most prominent imaging modality; however, transesophageal echocardiography and echocardiography were also found to be helpful. Additionally, a dynamic finite element simulation was also found to be an attractive alternative to the finite element analysis for an in-silico experiment. Nonetheless, there is a paucity of relevant publications and only sporadic evidence. More clinical studies have been warranted, notwithstanding that the derived data and results from this insight into the use of therapeutic interventions may be evidence of multiple directives in clinical practices and beyond. This study may help the integration of personalized devices for better comprehension of predicted clinical outcomes, thus leading towards enhanced performance gains.

An Innovative Customized Stent Graft Manufacture System Assisted by Three-Dimensional Printing Technology

BACKGROUND

Commercially available thoracic aortic stent grafts rarely match the geometric characteristics of the aorta perfectly, which can lead to complications. Customization maybe a solution for this problem, but the delay inherent in the current manufacturing process makes it unable to meet the urgent requirement of acute aortic events. We established and optimized a rapid design and manufacture system for a customized aortic stent graft assisted by 3-dimensional (3D) printing technology. We also evaluated the preliminary feasibility and capability of this customized stent graft.

METHODS

Seven essential production steps comprised the rapid design and manufacture process for the customized stent graft system assisted by 3D printing technology. Optimization of the manufacture process was refined over time in 3 stages. Bench test and in vivo experiments were used to verify the feasibility of this system and evaluate the preliminary usability of the customized stent graft.

RESULTS

After optimization, the theoretical production time of the customized stent graft was reduced to approximately 12 hours. Bench test showed radial forces against the aorta wall were better distributed in the customized stent graft than in the control stent graft. In vivo experimental results showed that the customized stent graft system worked effectively.

CONCLUSIONS

It was feasible to rapidly design and manufacture a customized aortic stent graft assisted by 3D printing technology, which demonstrated better geometric compliance and physical characters in the bench test and in in vivo experimentation. The manufacturing process could be accelerated to approximately 12 hours, which might be optimized further to meet urgent clinic requirements.

Design and evaluation of the crimping of a hooked self-expandable caval valve stent for the treatment of tricuspid regurgitation

To design a hooked self-expandable caval valve stent and determine the best crimping scenario for its percutaneous implantation in the Superior and Inferior Vena Cava (SVC & IVC) for the treatment of tricuspid regurgitation (TR). A hooked, Nitinol based stent design was modeled using SOLIDWORKS and finite element analysis (FEA) was carried out using ABAQUS. The Nitinol material used in this study was modeled in ABAQUS as superelastic-plastic. Two cases were simulated. In case A, the stent model was crimped to 18 F by compressing the stent main body and then: (i) bending both the proximal and distal hooks; (ii) straightening the proximal hooks and bending the distal hooks. In case B, the stent model was crimped to 18 F by: (i) bending the proximal and distal hooks and then compressing the stent main body; (ii) straightening the proximal hooks and bending the distal hooks and then compressing the stent main body. The maximum strain after crimping was used to evaluate the best crimping scenario. Hook straightening produced strains of 10.7% and 10.96% as opposed to 12.6% and 13.0% produced by hook bending. From comparison of results of both cases simulated, it was found that straightening the hooks gave lower strain and thus was the best crimping procedure. The analysis performed in this paper may help understand the critical issue of crimpability of the new stent design. The best crimping scenario can be found based on finite element modeling and simulation. Identifying the best crimping way will also help the design team to optimize the delivery system that will eventually be used to deploy this caval valve stent.

Applications of 3D printing in cardiovascular diseases

3D-printed models fabricated from CT, MRI, or echocardiography data provide the advantage of haptic feedback, direct manipulation, and enhanced understanding of cardiovascular anatomy and underlying pathologies. Reported applications of cardiovascular 3D printing span from diagnostic assistance and optimization of management algorithms in complex cardiovascular diseases, to planning and simulating surgical and interventional procedures. The technology has been used in practically the entire range of structural, valvular, and congenital heart diseases, and the added-value of 3D printing is established. Patient-specific implants and custom-made devices can be designed, produced, and tested, thus opening new horizons in personalized patient care and cardiovascular research. Physicians and trainees can better elucidate anatomical abnormalities with the use of 3D-printed models, and communication with patients is markedly improved. Cardiovascular 3D bioprinting and molecular 3D printing, although currently not translated into clinical practice, hold revolutionary potential. 3D printing is expected to have a broad influence in cardiovascular care, and will prove pivotal for the future generation of cardiovascular imagers and care providers. In this Review, we summarize the cardiovascular 3D printing workflow, from image acquisition to the generation of a hand-held model, and discuss the cardiovascular applications and the current status and future perspectives of cardiovascular 3D printing.

Three-Dimensional Printing: Basic Principles and Applications in Medicine and Radiology

The advent of three-dimensional printing (3DP) technology has enabled the creation of a tangible and complex 3D object that goes beyond a simple 3D-shaded visualization on a flat monitor. Since the early 2000s, 3DP machines have been used only in hard tissue applications. Recently developed multi-materials for 3DP have been used extensively for a variety of medical applications, such as personalized surgical planning and guidance, customized implants, biomedical research, and preclinical education. In this review article, we discuss the 3D reconstruction process, touching on medical imaging, and various 3DP systems applicable to medicine. In addition, the 3DP medical applications using multi-materials are introduced, as well as our recent results.