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Suitability of 3D-Printed Root Models for the Development of Transcatheter Aortic Root Repair Technologies


Ferrari, Enrico; Piazza, Giulia; Scoglio, Martin; Berdajs, Denis; Tozzi, Piergiorgio; Maisano, Francesco; Von Segesser, Ludwig Karl (2019). Suitability of 3D-Printed Root Models for the Development of Transcatheter Aortic Root Repair Technologies. ASAIO Journal, 65(8):874-881.

Abstract

Transcatheter aortic root repair (TARR) is still not available because of the complex anatomy. In order to develop future TARR technologies, a human-derived bench test model is required before performing animal tests. For this purpose, we aimed to validate computed tomography (CT)-derived 3D-printed root models for TARR technologies. Four human CT-derived roots were printed using different resins: Visijet M3 Crystal, Photopolymer gel SUP705, Formlabs flexible resin, and Materialise HeartPrint Flex. A stress test was performed using a 26-mm balloon-expandable Sapien valve deployed in aortic position. The too rigid Visijet M3 Crystal was not tested. Among the others, all but one (HeartPrint Flex) ruptured during the test showing low wall resistances. Further tests were then performed in two roots made of HeartPrint Flex resin. The anatomic validation was performed comparing human CT scan-derived 3D reconstructions and CT scan measurements: a mean difference of 0.57 ± 0.4 mm for aortic annulus diameter and for the distance between the aortic annulus and the coronary ostia was measured. Concerning the coronary arteries, they are of paramount importance for new TARR technologies, and therefore, we tested the coronary flows of the HeartPrint Flex root at different pressure levels. At 60 mm Hg, right and left mean adjusted coronary flows were 471 and 663 ml/min; at 80 mm Hg, right and left mean coronary flows were 551 and 777 ml/min; and at 100 mm Hg, right and left mean coronary flows were 625 and 858 ml/min. In our study, 3D-printed root models correlate well with human anatomy and guarantee physiologic coronary flows for TARR technologies.

Abstract

Transcatheter aortic root repair (TARR) is still not available because of the complex anatomy. In order to develop future TARR technologies, a human-derived bench test model is required before performing animal tests. For this purpose, we aimed to validate computed tomography (CT)-derived 3D-printed root models for TARR technologies. Four human CT-derived roots were printed using different resins: Visijet M3 Crystal, Photopolymer gel SUP705, Formlabs flexible resin, and Materialise HeartPrint Flex. A stress test was performed using a 26-mm balloon-expandable Sapien valve deployed in aortic position. The too rigid Visijet M3 Crystal was not tested. Among the others, all but one (HeartPrint Flex) ruptured during the test showing low wall resistances. Further tests were then performed in two roots made of HeartPrint Flex resin. The anatomic validation was performed comparing human CT scan-derived 3D reconstructions and CT scan measurements: a mean difference of 0.57 ± 0.4 mm for aortic annulus diameter and for the distance between the aortic annulus and the coronary ostia was measured. Concerning the coronary arteries, they are of paramount importance for new TARR technologies, and therefore, we tested the coronary flows of the HeartPrint Flex root at different pressure levels. At 60 mm Hg, right and left mean adjusted coronary flows were 471 and 663 ml/min; at 80 mm Hg, right and left mean coronary flows were 551 and 777 ml/min; and at 100 mm Hg, right and left mean coronary flows were 625 and 858 ml/min. In our study, 3D-printed root models correlate well with human anatomy and guarantee physiologic coronary flows for TARR technologies.

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Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Vascular Surgery
04 Faculty of Medicine > Cardiocentro Ticino
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:1 January 2019
Deposited On:19 Feb 2019 14:54
Last Modified:05 Nov 2019 02:01
Publisher:Lippincott Williams & Wilkins
ISSN:1058-2916
OA Status:Green
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.1097/MAT.0000000000000903
PubMed ID:30325848

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