Early results of optimal septal myectomy using 3-dimensional printed models

Abstract

Introduction The completeness of septal myectomy (SM) is the key to surgery of hypertrophic obstructive cardiomyopathy (HOCM), but its planning is still based on echocardiographic findings. The need to perform radical SM requires the development of new cardio-visualisation techniques for monitoring myectomy quality. Aim To improve results in centres treating few patients with HOCM using a new method of optimal SM with the help of 3-dimensional models to achieve an ‘ideal’ interventricular septum (IVS) thickness of 10–11 mm. Material and methods Between 2017 and 2018, 30 patients underwent optimal SM after computed tomography angiography, creation of a virtual 3-dimensional model of the IVS, computer-aided mapping, virtual SM and 3-dimensional printing of models of the ‘ideal’ IVS and the fragment to be removed. Results Initial isolated extended SM ( n = 29, 97%) was effective in 23/29 (79%) patients. Four non-fatal complications were observed. A permanent pacemaker was implanted in three patients. No patients required mitral valve replacement. The mean postoperative left ventricle (LV) resting systolic gradient was 7.5 ±4.4 mm Hg, and at the latest follow-up this value was 7.1 ±4.2 mm Hg. The average weight of the excised myocardium was 12.0 g (range: 5.8–22.5 g). At follow-up both volumetric and dimensional LV echocardiography parameters increased compared with preoperative values ( p ≤ 0.007). Conclusions The proposed optimal SM provides intraoperative monitoring of the shape and volume of the myocardium resected to achieve the ‘ideal’ IVS, true radicality and an increase in the volumetric and dimensional parameters of the LV.

Translating Imaging Into 3D Printed Cardiovascular Phantoms

“… 13 Across the largest studies, all investigators concluded that the use of 3DPSPs was positive and enhancing in the clinical management of patients with complex geometric cardiovascular conditions. 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 Tissue mimicry and poor representation of the cardiac valves were frequently shared concerns, particularly with single-material 3DPSPs. 22

Figure 3 Number of Studies Investigating Three-Dimensional Printed Cardiovascular Phantoms and 3-Year Trend Line

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Imaging-Based, Patient-Specific Three-Dimensional Printing to Plan, Train, and Guide Cardiovascular Interventions: A Systematic Review and Meta-Analysis

“…Both models, the native and the virtually treated one with its resected fragment guided the surgeon during the intervention in two cases. Besides these case reports, three prospective studies including more than five subjects systematically investigated 3DPSP before myectomy [38,40,41]. Authors evaluated them as a helpful tool in the planning of the intervention and for intraoperative guiding to achieve optimal septum thickness, whereas comparative studies are lacking.…”

How to build a successful hypertrophic cardiomyopathy team and ensure training the next generation of myectomy surgeons

“…The interactive PDF is easily portable, an advantage compared to 3-D printed heart models. [32][33][34][35][36][37] Readers can access our initial models through the publication by Oberoi et al 32 "Seeing" the operation A common problem in teaching septal myectomy has been the restricted view of the operative field for the assistant resident surgeon. We address this by using video obtained with a standard rigid endoscope directed to the LVOT or transapically when this approach is used.…”