Three-dimensional printing creates models for surgical planning of aortic valve replacement after previous coronary bypass grafting
Three-dimensional printing creates models for surgical planning of aortic valve replacement after previous coronary bypass grafting
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DOI：
10.1016/j.athoracsur.2007.12.033
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发表时间：
2008-06-01
影响因子：
4.6
通讯作者：
Schmitz, Christoph
中科院分区：
文献类型：
--
作者：
Sodian, Ralf;Schmauss, Daniel;Schmitz, Christoph
目的。既往行冠状动脉旁路移植术和乳腺内动脉移植术的患者，胸腔切开行主动脉瓣置换术可能是一个外科问题。因此，我们正在探索使用快速原型技术在术前冠状动脉搭桥术（CABG）后主动脉瓣置换术中的手术计划和术中定位的效果。作为概念的证明，我们研究了一位5年前接受过冠脉搭桥的患者。当时患者接受了左乳腺内动脉移植至左前降支，静脉移植至右冠状动脉。现在病人需要更换主动脉瓣因为有症状的主动脉瓣狭窄。左乳内动脉旁路术和右冠状动脉旁路术通畅，造影显示血流良好。患者行128层计算机断层扫描检查。对图像数据进行可视化和重构。然后，使用快速原型机制作显示解剖结构的复制品。利用128层计算机断层血管造影数据与专有软件相关联，我们能够创建先前CABG后血管解剖的三维重建。在手术过程中，对模型进行消毒并带到手术室进行定向。立体成像复制品有助于手术计划中治疗策略的选择以及既往冠脉搭桥患者再次手术时术中定位。
Purpose. Resternotomy for aortic valve replacement in patients with previous coronary artery bypass grafting and an internal mammary artery graft may be a surgical problem. Thus, we are exploring the effect of using rapid prototyping techniques for surgical planning and intraoperative orientation during aortic valve replacement after previous coronary artery bypass grafting ( CABG).Description. As a proof of concept, we studied a patient who had undergone CABG 5 years earlier. At that time the patient received a left internal mammary artery graft to the left anterior descending artery and a venous graft to the right coronary artery. Now the patient required aortic valve replacement due to symptomatic aortic valve stenosis. The left internal mammary artery bypass and the right coronary artery bypass were patent and showed good flow in the angiography. The patient was examined by 128-slice computed tomography. The image data were visualized and reconstructed. Afterwards, a replica showing the anatomic structures was fabricated using a rapid prototyping machine.Evaluation. Using data derived from 128-slice computed tomography angiography linked to proprietary software, we were able to create three-dimensional reconstructions of the vascular anatomy after the previous CABG. The models were sterilized and taken to the operating theatre for orientation during the surgical procedure.Conclusions. Stereolithographic replicas are helpful for choosing treatment strategies in surgical planning and for intraoperative orientation during reoperations of patients with previous CABG.