3-D Printing Opportunities Emerge for Cardiologists, Hospitals, and Device Companies Alike

DENVER, CO—Interest in using 3-D printing applications for cardiovascular care shows no sign of slowing down.

A session dedicated to the topic here yesterday at TCT 2017 included talks on institutional experience with the technology, use of 3-D printed models to help plan left atrial appendage closure (LAA) closure procedures, and a comprehensive commercial perspective.

So far in cardiology, 3-D printing has mostly been used for planning and educational purposes, with operators either practicing a procedure inside a 3-D printed model or trainees holding models in their hands to better learn anatomy.

“I used to think of 3-D printing as a toy, but I really do think now that there is utility,” commented panelist Jacqueline Saw, MD (Vancouver General Hospital, Canada). “You can almost simulate the entire procedure [and] you can conceive challenges . . . entirely outside of the patient.”

I used to think of 3-D printing as a toy, but I really do think now that there is utility. Jacqueline Saw

For the first presentation, Kishore Harjai, MD (Geisinger Wyoming Valley - Pearsall Heart Center, Wilkes-Barre, PA), gave an overview on how his institution has been using 3-D printing technology in cardiology. Since they began experimenting with it in October 2015, 40 physicians have ordered 54 prints from scans of 40 unique patients. Most physicians requesting the prints at his center were pediatric and adult imaging cardiologists, but interventional cardiologists, CT surgeons, and electrophysiologists have also made inquiries. The source data used were mostly from CT, although models were printed from MRI and 3-D transesophageal echocardiography images as well. Lastly, he explained, common interventional indications that the 3-D models were used for included paravalvular leak repair, LAA closure, and closure of aorta to RV fistula post-TAVR.

“3-D printing of the heart is an exciting new application with potential applications in planning complex interventions and surgery,” Harjai said. “Our experience so far is largely anecdotal. We think it will be useful in preplanning the fluoroscopic use approach, . . . can help us select catheters ahead of time, [and] can resolve anatomic ambiguities especially if you don't have a lot of experience with certain procedures. And I believe it [shortens] procedure times and lowers dye use and equipment, but this all remains to be proven.”

Future research should focus on “accuracy and efficiency and cost-effectiveness parameters,” he concluded.

Printing for Sizing

Next up, Vlad Ciobotaru, MD (Hopital Privé Les Francicaines, Nîmes, France), presented results of his study looking at the effect of 3-D printed models on device sizing in LAA closure cases.The study compared 55 LAA occlusion patients whose operators practiced on simulations retrospectively—but who were blind to the size of implanted device—and 21 patients whose operators practiced on 3-D simulations made of flexible photopolymer resin prior to their procedures. The latter group, said Ciobotaru, had fewer peridevice leaks, better sites for transseptal puncture, shorter procedures, and received fewer prostheses.

“This method may be integrated in a training program, particularly in low-volume or new centers, to improve success rates,” Ciobotaru said, adding that his group is starting the LAA-Print French Registry, which plans to enroll 400 patients from several centers in France.

Lastly, the founder and CEO of the med-tech company Biomodex, Thomas Marchand, MBA, gave an overview of the patient-specific models his team creates for physicians, hospitals, device companies, and even medical schools. The biggest challenges in 3-D printing right now, he explained in his presentation, are reproducing “complex organic heterogeneous tissues that behave the same inside the body” as well as convincing all of the different stakeholders—the med-tech industry, physicians, patients, medical imagers, hospitals, and payers—of the value of this technology.

Marchand’s company is different than most other 3-D printing technology companies, he explained to TCTMD, in that they don’t just sell individual patient models. Rather, they sell bundled packages that cost around $3,500 per patient that include everything physicians need to help plan a patient’s procedure.

With regard to the hesitation some have with regard to 3-D printing, Marchand said that “skepticism is good because it's challenging us. . . . You need to have skeptical people if you want to make something that is valuable.”

Skepticism is good because it's challenging us. . . . You need to have skeptical people if you want to make something that is valuable. Thomas Marchand, MBA

In a panel discussion at the end of the session, Mathew Williams, MD (NYU Langone Medical Center, New York, NY), said that his team has “really found [3-D printing] to be useful, especially with the new technologies. The system I’m working with is transseptal, so to kind of do the navigation [on a model, preprocedure], factoring in the left atrium and then make sure [the device] sits well is helpful.” However, it is yet to be determined how relevant 3-D modeling will be after operators gain more experience, he added.  

Likewise, panelist Charles Davidson, MD (Northwestern Memorial Hospital, Chicago, IL), said that 3-D printing is “already the gold standard for training on new device technologies, . . . because the animal models are not very good.” Still, he said, “what I’d like to see going beyond that is, what are the applications in a larger population of physicians and trainees? And how can [the technology be used] once we get beyond the early technology development and training?”

Photo credit: Dee Wang, MD (Henry Ford Hospital, Detroit, MI).