ABSTRACT
Abstract Introduction: Three-dimensional (3D) printing has become an affordable tool for assisting heart surgeons in the aorta endovascular field, both in surgical planning, education and training of residents and students. This technique permits the construction of physical prototypes from conventional medical images by converting the anatomical information into computer aided design (CAD) files. Objective: To present the 3D printing feature on developing prototypes leading to improved aortic endovascular surgical planning, as well as transcatheter aortic valve implantation, and mainly enabling training of the surgical procedure to be performed on patient's specific condition. Methods: Six 3D printed real scale prototypes were built representing different aortic diseases, taken from real patients, to simulate the correction of the disease with endoprosthesis deployment. Results: In the hybrid room, the 3D prototypes were examined under fluoroscopy, making it possible to obtain images that clearly delimited the walls of the aorta and its details. The endovascular simulation was then able to be performed, by correctly positioning the endoprosthesis, followed by its deployment. Conclusion: The 3D printing allowed the construction of aortic diseases realistic prototypes, offering a 3D view from the two-dimensional image of computed tomography (CT) angiography, allowing better surgical planning and surgeon training in the specific case beforehand.
Subject(s)
Humans , Male , Female , Aged , Aortic Diseases/surgery , Preoperative Care/methods , Endovascular Procedures , Patient-Specific Modeling , Printing, Three-Dimensional , Aortic Diseases/diagnostic imaging , Treatment Outcome , Computed Tomography AngiographyABSTRACT
A estenose aórtica degenerativa é a doença valvar adquirida mais comum em adultos, acometendo principalmente os idosos. A cirurgia de substituição da valva aórtica é o tratamento de escolha nos pacientes com estenose aórtica importante sintomática. Seus resultados são reproduzíveis e bem estabelecidos. Porém, cerca de um terço dos pacientes são considerados inoperáveis devido ao risco cirúrgico inaceitável. Em consequência, nos últimos anos, novas alternativas de tratamento intervencionista foram introduzidas na prática clínica, com resultados iniciais favoráveis. Atualmente, as opções englobam a cirurgia de troca da valva aórtica, o implante da valva aórtica transcateter e, mais recentemente, a cirurgia de troca valvar aórtica sem sutura. Técnicas cirúrgicas minimamente invasivas não demonstraram diferença na mortalidade, porém chamam a atenção pelo resultado similar à esternotomia clássica, melhor resultado estético e menor tempo de hospitalização. Além disso, para evitar a utilização de próteses, técnicas de reconstrução valvar têm sido descritas. No implante de valva transcateter, o treinamento de equipe multidisciplinar é mandatório para a criteriosa seleção dos pacientes e da via de acesso. Os acessos transapical e transaórtico evoluíram como opções eficazes e vantajosas nos pacientes não candidatos para a via femoral. A familiaridade dos cirurgiões com essas abordagens tem contribuído para os bons resultados descritos. Um centro que seja capaz de oferecer todas essas alternativas de tratamento poderá selecionar a técnica mais apropriada, considerando a preferência do paciente e avaliando características fundamentais como idade, comorbidades, fragilidade e anatomia. Experiente "Heart Team" será capaz de fazer a escolha mais adequada.
Degenerative aortic stenosis is the most common acquired valvular disease in adults, affecting mainly the elderly. Surgical aortic valve replacement is the treatment of choice in patients with severe symptomatic aortic stenosis. Its results are reproducible and well established. However, about one third of patients are considered inoperable because of unacceptable surgical risk. Therefore, in the past few years, new alternative interventional treatments were introduced in clinical practice, with favorable initial results. Currently, the options include surgical aortic valve replacement, transcatheter aortic valve implantation and more recently, sutureless aortic valve replacement. Minimally invasive surgical techniques showed no difference in mortality, but caIl attention for similar result to the classic sternotomy, better cosmetic effect and shorter length of hospital stay. Furthermore, to avoid the use of prostheses, valve reconstruction techniques have been described. In transcatheter valve implantation, training multidisciplinary team is mandatory for careful selection of patients and access routes. The transapical and transaortic approaches evolved as effective and advantageous options in patients not candidates for transfemoral access. The familiarity of surgeons with these routes has contributed to the good results described. A center that is able to offer ali of these therapeutic alternatives can select the most appropriate technique, considering the patient' s preferences and evaluating crucial characteristics such as age, comorbidities, frailty and anatomy. An experienced "Heart Team" will be able to make the most adequate choice.