3D-printing model for complex aortic transcatheter valve treatment

Trans-catheter valve implantation; Aortic valve regurgitation, 3D printing; Stereolitography
The 3D printing applications in medicine are expanding rapidly and are estimated to revolutionize health care. 3D-printed cardiovascular models can be particularly helpful to “the heart team” by providing a custom-made representation of the heart before an interventional procedure.

A 79 years old patient with severe comorbidities (hypertension, diabetes mellitus, chronic kidney disease, dyslipidemia, atrial fibrillation, epilepsy, thalassemia minor and monoclonal gammopathy of undetermined significance) was referred for severe aortic regurgitation (Online Video 1). After a multidisciplinary heart team evaluation [1], the patient was scheduled for an “off-label” procedure using a CoreValve Evolut R 29 mm (Medtronic, Inc., Minneapolis, MN, USA) [2]. The patient has undergone previous surgery for an aneurism involving the ascending aorta and the brachiocephalic trunk. A dacron graft was used to replace the bulging section of the ascending aorta and the brachiocephalic trunk was re-implanted proximal to the aortic annulus. A 64-row multi-detector computed tomography (MDCT) was performed to provide high-resolution images of the aorta (Fig. 1A) in order to evaluate the anatomic relationship between the brachiocephalic trunk and the aortic annulus. CoreValve Evolut R 29 mm has a recognized height of 55 mm [3] and [4]. After generating a STL (Stereolitography) file out the Dicom data set of MDCT [5], the pre-operative 3D-printed model was useful to rule out the risk of occlusion of the brachiocephalic trunk during the stent-valve deployment (Fig. 1B). The self-expandable transcatheter valve was positioned and deployed under fluoroscopic vision using the transfemoral route (Fig. 1C). The procedure was uneventful and angiography confirmed optimal stent-valve positioning and a preserved flow in the brachiocephalic trunk (Online Video 2). Echocardiography showed a well functioning valve with no paravalvular leaks (Online Video 3).