Hearts printed in 3D for planning complex operations.

Specialists at the Virgen del Rocío Hospital in Seville print 3D replicas of hearts with severe congenital cardiopathies in order to prepare surgical interventions with greater accuracy.

Each heart is unique. Its size, internal cavities and the way in which it is connected with the large vessels around it are factors that differ from case to case. Given this, when it comes time to prepare an intervention to treat a severe congenital cardiopathy (this type of malformation occurs in eight out of every 1000 newborns), it is essential to have precise information about each patient's anatomical structures. 

“The more information available in advance about the shape of the heart, the easier it is for the surgeon to successfully tackle the intervention and the less chances there are of unforeseen complications”, explains Gorka Gómez Ciriza, a collaborating researcher from the Technological Innovation Group at the Virgen del Rocío Hospital in Seville, who for the last five years has worked with 3D printers to improve surgical intervention planning. 

“Paediatric cardiology is where the use of this technology is having the biggest impact, especially since we started using flexible filaments to print heart replicas. This really facilitates exploration for the surgeons”,he adds.  Given these 3D replicas are generated from magnetic resonance and CT images, they perfectly recreate the unique shape of the organs. Being able to handle these replicas helps specialists determine the best approach to an intervention before entering the operating room. 

From the screen to your hands

Before making the move to printing, this clinical innovation team was already working with 3D imaging software for preparing operations. “In 2005 we started developing virtual surgical-planning software in the hospital using magnetic resonance and CT images”, he explains. This program allowed interventions to be prepared in detail given that it enabled them to view, on screen, the internal structure of the organs, bones and other structures involved in the operation.  

Después,  Afterward, in 2011, they took the plunge into 3D printing and started to print models of mandibles, skulls, fibulae, etcetera. “Having the patient's anatomy in the surgeon's hand is far more useful than viewing it on a computer screen”, explains Gorka. 

Since 2006 they have made more than 1500 virtual reconstructions of patient cases  and since 2011 they have printed parts for patients in more than 400 of these cases. 

corazón impreso en BQ Witbox

The arrival of flexible filaments

The turning point arrived in 2013 when they started to work with a Witbox printer. This constituted a “significant leap in quality” as it allowed them to print with flexible filaments for the first time. “Thanks to this we started to work with new specialities such as paediatric cardiology, which is where the biggest impact is being seen” he adds.“Preparatory work is of vital importance to the surgeon given that access to the heart during cardiac surgery is not easy”, explains Gorka.

Cardiovascular surgeons now have the chance to touch the flexible heart replicas, “they explore and analyse how the internal cavities of the organ are formed. I've even seen them inserting fingers into the models to feel the shape of the cavities, which is something they couldn't do with the rigid models”, says the researcher.

A unique model for each heart

They have since created and distributed models of hearts to several international and Spanish hospitals. The flexibility of the models provides surgeons with more potential when preparing operations and exploring anatomy. It should be noted that surgery on this type of cardiopathy is extremely complicated given the anatomical variability between organs, even within the same type of malformation. “This is why 3D printing is so useful, it provides exact, customised solutions for each patient”, adds Gorka. 

This is why 3D printing is so useful, it provides exact, customised solutions for each patient

Since the start of the 'Personalised surgical planning of complex congenital cardiopathies using personalised 3D biomodels' research project, professionals have performed 40 surgeries on children with severe congenital cardiopathies in more than 10 hospitals worldwide.  So far, the result of surgical planning based on these printed biomodels of organs is, according to Gorka, 
“improved surgical accuracy, reduced surgery time and a higher intervention success rate”
.

The successful experience has led them to share their achievements with the scientific community: they have published more than 10 articles in national and international scientific magazines. Where to next? The pursuit of synergies between engineers, surgeons and other specialists with regard to 3D printing, in order to continue increasing operation success rates.