Affiliation:
1. Department of Thoracic and Cardiovascular Surgery, German Heart Institute Berlin, Germany
2. Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité – Universitätsmedizin Berlin, Germany
3. 3D Lab Institute of Mathematics, Faculty II - Mathematics and Natural Sciences, Technische Universität Berlin, Germany
Abstract
Objective The right anterior lateral thoracotomy (RALT) approach for aortic valve replacement provides excellent outcomes in expert hands while avoiding sternal disruption. It, however, remains a technically demanding niche operation. Instrument trajectories via this access are influenced by patient anatomy, the intercostal space chosen, and surgical retraction maneuvers. Methods To simulate the typical surgical maneuvers, on an anatomically accurate model, and to measure the instrument trajectories, we generated a 3-dimensional (3D) printed model of the heart and chest cavity. A simulated approach to the base of the right coronary sinus via the medial-second intercostal, the lateral-second intercostal, or third intercostal space was made. Keeping the instrument in place, 3D scans of the models and geometrical measurements of the instrument trajectories were performed. Results The 3D scans of the 3D printed model showed a high fidelity when compared to the original computed tomographic scan image geometry (mean deviation of 1.26 ± 1.27mm). The instrument intrathoracic distance was 75 mm via the medial-second, 115 mm via the lateral-second, and 80 mm via the third intercostal space. The 3D angulation of the instrument to the incision was 33.77o, 55.93o, and 38.4o respectively. The distance of the instrument to the lateral margin was 12, 26, and 5 mm respectively. The cranial margin of the incision was always a limiting margin for the instrument. Conclusions Three-dimensional printing and 3D scanning facilitated a realistic simulation of the instrument trajectory during RALT approach. The lateral-second intercostal approach showed the most favorable approach angle and distance from the lateral margin, although it also had the longest intrathoracic distance.
Subject
Cardiology and Cardiovascular Medicine,General Medicine,Surgery,Pulmonary and Respiratory Medicine
Cited by
5 articles.
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1. Teaching heart valve surgery techniques using simulators: a systematic review;Canadian Journal of Surgery;2023-03-17
2. The Use of Three-Dimensional Printing in Cardiac Structural Disease: A Review;Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery;2023-03
3. Application of 3D Printing Technology in the Medical Field;Recent Advances in Electrical & Electronic Engineering (Formerly Recent Patents on Electrical & Electronic Engineering);2022-12
4. Virtual reality in cardiac interventions—New tools or new toys?;Journal of Cardiac Surgery;2022-05-24
5. A APPLICATION OF 3D HEART MODELS CREATED ON DICOM DATA IN MEDICAL PRACTICE;Diagnostic radiology and radiotherapy;2020-09-09