Imaging-Based, Patient-Specific Three-Dimensional Printing to Plan, Train, and Guide Cardiovascular Interventions: A Systematic Review and Meta-Analysis

Benedikt Bernhard; Joël Illi; Martin Gloeckler; Thomas Pilgrim; Fabien Praz; Stephan Windecker; Andreas Haeberlin; Christoph Gräni

doi:10.1016/j.hlc.2022.04.052

Imaging-Based, Patient-Specific Three-Dimensional Printing to Plan, Train, and Guide Cardiovascular Interventions: A Systematic Review and Meta-Analysis

Heart Lung Circ. 2022 Sep;31(9):1203-1218. doi: 10.1016/j.hlc.2022.04.052. Epub 2022 Jun 7.

Authors

Benedikt Bernhard¹, Joël Illi², Martin Gloeckler¹, Thomas Pilgrim¹, Fabien Praz¹, Stephan Windecker¹, Andreas Haeberlin³, Christoph Gräni⁴

Affiliations

¹ Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
² Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Swiss MedTech Center, Switzerland Innovation Park Biel/Bienne AG, Switzerland.
³ Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Translational Imaging Center, Sitem Center, University of Bern, Switzerland.
⁴ Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Translational Imaging Center, Sitem Center, University of Bern, Switzerland. Electronic address: christoph.graeni@insel.ch.

PMID: 35680498
DOI: 10.1016/j.hlc.2022.04.052

Abstract

Background: To tailor cardiovascular interventions, the use of three-dimensional (3D), patient-specific phantoms (3DPSP) encompasses patient education, training, simulation, procedure planning, and outcome-prediction.

Aim: This systematic review and meta-analysis aims to investigate the current and future perspective of 3D printing for cardiovascular interventions.

Methods: We systematically screened articles on Medline and EMBASE reporting the prospective use of 3DPSP in cardiovascular interventions by using combined search terms. Studies that compared intervention time depending on 3DPSP utilisation were included into a meta-analysis.

Results: We identified 107 studies that prospectively investigated a total of 814 3DPSP in cardiovascular interventions. Most common settings were congenital heart disease (CHD) (38 articles, 6 comparative studies), left atrial appendage (LAA) occlusion (11 articles, 5 comparative, 1 randomised controlled trial [RCT]), and aortic disease (10 articles). All authors described 3DPSP as helpful in assessing complex anatomic conditions, whereas poor tissue mimicry and the non-consideration of physiological properties were cited as limitations. Compared to controls, meta-analysis of six studies showed a significant reduction of intervention time in LAA occlusion (n=3 studies), and surgery due to CHD (n=3) if 3DPSPs were used (Cohen's d=0.54; 95% confidence interval 0.13 to 0.95; p=0.001), however heterogeneity across studies should be taken into account.

Conclusions: 3DPSP are helpful to plan, train, and guide interventions in patients with complex cardiovascular anatomy. Benefits for patients include reduced intervention time with the potential for lower radiation exposure and shorter mechanical ventilation times. More evidence and RCTs including clinical endpoints are needed to warrant adoption of 3DPSP into routine clinical practice.

Keywords: 3D printing; Additive manufacturing; Cardiovascular intervention; Patient specific phantoms; Personalised medicine.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Diagnostic Imaging
Heart Defects, Congenital*
Humans
Printing, Three-Dimensional*
Prognosis