3D printing integrated with multimodality imaging for planning periprosthetic leak closures

Abstract

Percutaneous closure of the paravalvular leak (PVLc) has emerged as a palliative alternative to surgical management in selected cases. A multimodal imaging analysis before and during the procedure is mandatory to choose the better device based on anatomical factors. However, it remains challenging in achieving complete leak occlusion, while respecting prosthesis function. 3D printed models have emerged as a useful tool to assist complex cardiac interventions. To explore the additional value of 3D printing integrated with multimodality imaging in predicting complications including mechanical valve leaflets blockade, device embolization, residual shunt. We selected 11 PVLc procedures from 3 centers in which 3D printed model were used prior to the procedure from the prospective FFPP registry between 2017 and 2019 (NCT05089136). Cardiac CT was used for segmentation for 3D printed (3D-heart modeling, Caissargues, France). Technology used a laser to fuse very fine powders [thermoplastic polyurethane (TPU)] into a final part – laser sintering technology (SLS) with an adapted elasticity. A simulation on 3D printed model was performed before the procedure. Four PVLc mitral prostheses (3 mechanical). Six aortic: 2 biological, 2 suturesless, 2 mechanical. One PVLC post-tricuspid annuloplasty (Fig. 1). The device chosen on 3D model matched with in situ one in 8/11 cases without residual leakage. A risk of prosthesis blocage was detected in 5 cases. In one patient the plug was not implanted, in another the plug was removed, in another case the orientation of the plug was optimally adapted according to the simulation while in 2 patients, the plug-induced blockage detected during the 3D printing simulation occurred delayed after the procedure when the loading conditions changed. 3D printing can be integrated into the multimodal planning of PVLc procedures. It improves the detection of the risk of complications such as leaflet blockage or residual leakage through a direct study of the interaction between the devices and the prosthesis, taking into account the deformations of both the devices and the surrounding structures.