Simulation of a Right Anterior Thoracotomy Access for Aortic Valve Replacement Using a 3D Printed Model

Abstract

<jats:sec><jats:title>Objective</jats:title><jats:p> The right anterior lateral thoracotomy (RALT) approach for aortic valve replacement provides excellent outcomes in expert hands while avoiding sternal disruption. It, however, remains a technically demanding niche operation. Instrument trajectories via this access are influenced by patient anatomy, the intercostal space chosen, and surgical retraction maneuvers. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> To simulate the typical surgical maneuvers, on an anatomically accurate model, and to measure the instrument trajectories, we generated a 3-dimensional (3D) printed model of the heart and chest cavity. A simulated approach to the base of the right coronary sinus via the medial-second intercostal, the lateral-second intercostal, or third intercostal space was made. Keeping the instrument in place, 3D scans of the models and geometrical measurements of the instrument trajectories were performed. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> The 3D scans of the 3D printed model showed a high fidelity when compared to the original computed tomographic scan image geometry (mean deviation of 1.26 ± 1.27mm). The instrument intrathoracic distance was 75 mm via the medial-second, 115 mm via the lateral-second, and 80 mm via the third intercostal space. The 3D angulation of the instrument to the incision was 33.77<jats:sup>o</jats:sup>, 55.93<jats:sup>o</jats:sup>, and 38.4<jats:sup>o</jats:sup> respectively. The distance of the instrument to the lateral margin was 12, 26, and 5 mm respectively. The cranial margin of the incision was always a limiting margin for the instrument. </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> Three-dimensional printing and 3D scanning facilitated a realistic simulation of the instrument trajectory during RALT approach. The lateral-second intercostal approach showed the most favorable approach angle and distance from the lateral margin, although it also had the longest intrathoracic distance. </jats:p></jats:sec>

The Use of Three-Dimensional Printing in Cardiac Structural Disease: A Review

“…After full-text review, 37 articles were included in qualitative analysis. 17–53 Supplemental Figure 1 describes this article selection process. In clinical trials, clinical benefit can be described as any favorable effect on patient outcome, either through symptom management, functionality, or survivability.…”

Teaching heart valve surgery techniques using simulators: a systematic review

“…The most common approaches used today are the sternotomy, hemisternotomy and transcatheter approaches, although the prevalence of thoracotomy has increased in recent years. 13 In addition to native valve excision and AV replacement (AVR), the surgical procedure involves sternotomy, initiation of cardiopulmonary bypass and adequate closure of the sternotomy, all of which are complex techniques individually. In this section, we focus on models simulating AVR.…”

“…Several high-fidelity simulators have been produced with the use of animal or human tissue and realistic procedures. 13 , 15 , 22 – 25 Fann and colleagues 22 described their AV model in which a porcine heart is placed in a container simulating the operating room exposure for AVR. Bouma and colleagues 15 described their high-fidelity model used for both open and transcatheter AV repair or AVR.…”

Virtual reality in cardiac interventions—New tools or new toys?

“…For example, training of ventricular septal defect repair on a silicone model of a heart is described as a useful method to improve OR planning 18 . In adult cardiac procedures, 3D‐printed models can help in planning access, for example in surgical minimally invasive aortic valve replacement 19 or to avoid complications in transcatheter aortic valve implantation 20 . The very recent trend is to integrate 3D models into virtual reality applications, as described in the paper by Kenichi and colleagues presented in this issue.…”