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We demonstrate the utility of a printed 3-dimensional model to assist in the vascular access planning for a transcatheter aortic valve replacement in an elderly woman with complicated vascular anatomy including aortic coarctation, severe iliofemoral disease, and a small and tortuous left subclavian artery. (Level of Difficulty: Intermediate.)
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The presence of aortobifemoral bypass graft can complicate vascular access during percutaneous intervention. Choosing an access route for transcatheter aortic valve replacement (TAVR) in this patient population can be challenging. Access options are further limited by the presence of coexisting vascular comorbidities such as extensive peripheral ar...
Citations
... Advances in 3-dimensional (3D) printing have proven its value and potential in many fields, in particular by opening up new approaches for the diagnosis and treatment of many complex cardiovascular diseases. Clinicians who specialize in diagnostic and interventional radiology could use imaging data to complete 3D reconstructions and models and to provide the surgeons with clear models of the individualized anatomical structures [6][7][8]. These clinicians collect the patients' preprocedural computed tomography angiography (CTA) imaging data to reconstruct 3D models and use the 3D printer to create individualized models [9,10]. ...
Transcatheter aortic valve replacement (TAVR) is a rapidly developing, cutting-edge technology. The skills to perform such procedures are difficult to acquire, and the learning curve is steep. In recent years, structural heart diseases, particularly valvular disease, have become one of the main areas to which 3-dimensional (3D) printing has been applied because it facilitates visualization and exploration of complex cardiovascular anatomical structures. 3D printing also addresses some of the challenges of these interventions, such as patient selection, prosthesis sizing, and of course, teaching and training. 3D printing can provide a valuable resource for teaching and training because it can produce educational models for all types of valvular diseases. A pulsatile platform for the simulation of TAVR with 3D printed models could be used for comprehensive training of young clinicians as part of the overall TAVR teaching and training program. In this review, we introduced the 3D printed model and TAVR simulator, illustrate its training applications in morphology teaching, surgical simulations and preprocedural planning. Additionally, we reviewed studies on 3D printing in predicting periprocedural complications of TAVR, discussed the current limitations and prospected future directions of 3D printing.
... With the continuous development of medical visualization, digital modeling is required to be increasingly accurate, and the requirement of precision is particularly important in cardiovascular diseases [7]. The emergence of cardiovascular 3-dimensional (3D) printing has brought new ideas and methods to many complex diagnoses and treatments of cardiovascular diseases, provided proceduralists with individualized models, and helped them be clear about the anatomic structures at a glance [8][9][10]. With the continuous improvement 3D printing, there have been scattered reports that this technology may assist the successful implementation of TAVR [11][12][13]. ...
In the study of TAVR, 3-dimensional (3D) printed aortic root models and pulsatile simulators were used for simulation training and teaching before procedures. The study was carried out in the following three parts: (1) experts were selected and equally divided into the 3D-printed simulation group and the non-3D-printed simulation group to conduct four times of TAVR, respectively; (2) another 10 experts and 10 young proceduralists were selected to accomplish three times of TAVR simulations; (3) overall, all the doctors were organized to complete a specific questionnaire, to evaluate the training and teaching effect of 3D printed simulations. For the 3D-printed simulation group, six proceduralists had a less crossing-valve time (8.3 ± 2.1 min vs 11.8 ± 2.7 min, P < 0.001) and total operation time (102.7 ± 15.3 min vs 137.7 ± 15.4 min, P < 0.001). In addition, the results showed that the median crossing-valve time and the total time required were significantly reduced in both the expert group and the young proceduralist group (all P<0.001). The results of the questionnaire showed that 3D-printed simulation training could enhance the understanding of anatomical structure and improve technical skills. Overall, cardiovascular 3D printing may play an important role in assisting TAVR, which can shorten the operation time and reduce potential complications.
... The emergence of 3D printing has brought new ideas and methods to the diagnosis and treatment of many complex cardiovascular diseases. Doctors could use imaging data to complete 3D reconstructions and models and provide surgeons with a clear understanding of the individualized anatomical structures (Alasnag et al. 2020;Bompotis et al. 2017;Alamir et al. 2020). ...
Transcatheter aortic valve replacement (TAVR) has been performed for nearly 20 years, with reliable safety and efficacy in moderate- to high-risk patients with aortic stenosis or regurgitation, with the advantage of less trauma and better prognosis than traditional open surgery. However, because surgeons have not been able to obtain a full view of the aortic root, 3-dimensional printing has been used to reconstruct the aortic root so that they could clearly and intuitively understand the specific anatomical structure. In addition, the 3D printed model has been used for the in vitro simulation of the planned procedures to predict the potential complications of TAVR, the goal being to provide guidance to reasonably plan the procedure to achieve the best outcome. Postprocedural 3D printing can be used to understand the depth, shape, and distribution of the stent. Cardiovascular 3D printing has achieved remarkable results in TAVR and has a great potential.
... Several successful examples have been published as case reports delineating the role of 3D printing are available including that of transcatheter aortic valve replacement (TAVR), tricuspid valve replacement, left ventricular assist devices, and congenital heart defects. [3][4][5] Figures 1 and 2 are examples of patient specific 3D printed models used to plan tricuspid valve replacement of a patient with a permanent pacemaker and leads across the valve as well as 3D printed model used to identify the appropriate access for TAVR in a patient with coarctation of the aorta. Larger series have allowed more streamlined guidance into the role of printed models for a variety of procedures such as mitral valve interventions, paravalvular leak closure, left atrial appendage occlusion and trans-septal punctures. ...
Purpose of Review
Although simulation was adopted many years ago to complement training programs, more recently it has become an integral part of planning individual invasive procedures as well as understanding and developing new devices and techniques. Here, we review the different types of simulation and modeling and their impact on the field of interventional cardiology.
Recent Findings
Three-dimensional model printing has been employed to strategize complex structural procedures for various congenital heart defects and valvular heart diseases. Ex vivo bench testing permitted understanding the relationship of new technologies with neighboring structures and enabled the refinement of the devices and procedural steps themselves. In vitro simulation and computational analyzes have enhanced our understanding of flow dynamics in bifurcation diseases, transcatheter therapies, congenital defects, and predicting outcomes for transcatheter valve technologies and techniques.
Summary
Incorporating simulation, bench testing, computational analyzes, and three-dimensional modeling will enable the field of interventional cardiology to expand while optimizing techniques and maintaining best practices.
... ). Conversely, a trans-subclavian access on the 3D model (Figures 6 to 8in the paper by Alasnag et al.[12]) suggested a more straightforward valve delivery, eventually leading to an uncomplicated TAVR procedure performed using this access approach.The authors should be commended for their preparedness and detailed planning in anticipation of a potentially complex and risky intervention.Although the MDCT images allowed for planning regarding the aortic annular size, aortic arch diameter, and the diameter and precise location of the coarctation and its post-coarctation dilatation (in the event a transaortic approach was to be considered), we believe that the use of the 3D model to simulate the procedure, and particularly the vascular access entry point, allowed the operators to clearly choose a less-invasive transarterial approach despite an apparent unfavorable anatomy that still allowed for the delivery system to be advanced freely into the aortic annulus; thus, they avoided the risks associated with a more intrusive transthoracic TAVR approach. The STL file provided by the authors permits a detailed view of the reconstructed 3D model showcasing a type 1b bicuspid aortic valve (13), a very tortuous aortic ...
Purpose of Review
Medical education has evolved remarkably during the last decade whereby the conventional large lecture halls, long didactic presentations, and textbooks have been replaced by smaller groups with a mentor–mentee pairing coupled with technological advances that permit a more intimate and yet comprehensive learning experience. The purpose of this review is to summarize the novel models of education and serve as a reference for educators.
Recent Findings
In the wake of a global pandemic, coronavirus-19 infection, higher education replaced conventional lecture hall formats with novel methods that are not face-to-face classes ushering in a new era of medical education. Recent studies have shown that social media has gradually emerged as an essential ancillary educational tool in cardiology. These studies recommend the integration of social media as well as other remote learning tools such as augmented reality, virtual reality, and smart glasses into the standard bedside and didactic curricula. However, educators will need research-based guidelines to inform instructional planning and implementation that ensure adequate exposure and fulfillment of the necessary competency requirements.
Summary
The current role of social media, medical computer software applications, online tools, and virtual platforms and technology play a valuable role in modern-day cardiology training. This review examines each of these tools’ advantages and disadvantages as well as the notable gap in knowledge.
We report a complex case of a 53-year-old male patient with recurrent ischemic ventricular septal defect that had been occluded by a surgical patch. Treatment was accomplished utilizing a 3-dimensional-printed model for preprocedural planning. In the future, printing of 3-dimensional models could offer new therapeutic strategies on an individual level. (Level of Difficulty: Intermediate.).
