A New Era in Surgical Planning: Patient-Specific Surgical Rehearsals Transform Care for Complex Congenital Surgeries.

by Jacques Zaneveld

Coauthors: Kenneth Liao, M.D., Dr. Harveen Lamba, M.D., Ward Shalash, Ph.D., Maria Pinero, N.P., Smriti Zaneveld, Ph.D.

Medical Devices & Digital Health

While 3D printing in healthcare has been a hot topic for at least a decade, the majority of 3D printing platforms are focused on the visualization of patient anatomy. Typical solutions do not allow surgeons to realistically operate on patient 3D models or physically test their surgical approach. This study examines the use of Preoperative Surgical Rehearsal (Pre-Sure) technology, which creates patient models in tissue-mimicking materials to aid in surgical decision making for an adult congenital heart defect patient.

The patient was referred to the Texas Heart Institute where she presented with a failing mitral valve, hypertension and extremely complex anatomy. When the patient was a child, she had been diagnosed with a complex set of congenital heart defects (CHD). At the time, under the care of Dr. Denton Cooley, the patient had received multiple surgeries, and also received care in her adulthood including the implantation of a conduit in the right ventricle of the patient, a pacemaker, and an artificial mitral valve. In order to better appreciate the complex anatomy of the patient, both a digital 3D rendering (Digital Twin) and a physical Pre-Sure model of the patient were produced by Lazarus 3D. The physical model was made at the exact scale of the patient’s heart in realistic materials recapitulating the patients’ anatomy.

Sonography Doppler Flow Imaging was also acquired to better understand flow between the patient’s left ventricle and left atrium. Alignment of the sonography images onto the digital 3D model was useful in interpreting the Doppler data, and supported a diagnosis of mitral regurgitation. Analysis of the 3D models also showed that the artificial valve had become impacted against the edge of the conduit. Given that the patient had high pulmonary hypertension, a medical contraindication for surgery, combined with knowledge obtained from the physical Pre-Sure specimen, the patient was precluded from surgical valvular repair. The patient was instead listed for heart transplant upon resolution of pulmonary hypertension. The Pre-Sure platform allowed the surgeons to thoroughly consider the surgical risks of valve repair versus the risk of heart transplant, and ultimately the decision to not proceed with valvular surgery was deemed to be the best treatment plan.

Similarly, the Pre-Sure platform shows promise for patients with complex developmental defects, including for colorectal, brain, and other heart conditions. Although additional research is required, the presented CHD case demonstrates the utility of Pre-Sure providing surgeons with a more direct understanding of the patient anatomy, not only through visualization, but also through next-generation preoperative hands-on surgical rehearsals. This unique opportunity to exercise, test and validate treatment plans through surgical rehearsals may improve patient safety and assurance on a personalized scale. This new technology warrants further investigation, especially for patients with unique aberrant anatomy and for complex surgical approaches.