Can 3D Printed Models of Coronary Anatomy Reduce the Risk of Major Complications During Personalized External Aortic Root Support (PEARS) surgery? A Pilot Study
Presented During:
Thursday, April 25, 2024: 5:38PM - 7:00PM
Sheraton Times Square
Posted Room Name:
Central Park
Abstract No:
P0073
Submission Type:
Abstract Submission
Authors:
Alastair Graham (1), Harvey Graham (2)
Institutions:
(1) Blackrock Clinic, Dublin, Ireland, (2) University of Galway, Galway, Ireland
Submitting Author:
Alastair Graham
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Blackrock Clinic
Blackrock Clinic
Co-Author:
Harvey Graham
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University of Galway
University of Galway
Presenting Author:
Alastair Graham
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Abstract:
Objective: PEARS is a relatively new surgical option for aneurysms of the aortic root and
ascending aorta with less than 900 completed worldwide to date. Its proposed advantages over
aortic root replacement include a shorter operation time, retention of the normal aortic valve
leaflets and function and, as there is no prosthetic tissue in contact with the bloodstream, a
reduced lifetime risk of endocarditis. Although in most cases cardiopulmonary bypass (CPB) is not
required, it remains a technically challenging operation that carries a risk of coronary artery
ischaemia requiring emergency intervention. We hypothesised that the incidence of coronary
injury may be reduced by the use of 3D printed models of the coronary artery anatomy as a guide
to the surgeon during dissection and carried out a pilot study.
Methods: A retrospective study was carried out on the first 14 patients in our PEARS programme.
Major complications and duration of follow-up were recorded. A prospective pilot study was
performed using 3D-printed models of the coronary artery anatomy used to guide dissection in 6
consecutive patients.
Results: There was a combined total of 20 patients in the two studies. Their mean age was 37
years (range 17 to 62) and 4 were female. The diagnosis was Marfan syndrome (MS) in 10, Loeys-
Dietz in 3, autosomal dominant connective tissue disorder in 3 and idiopathic in 4. All operations
were completed without the use of CPB, bar two with concomitant mitral valve repair.
All patients survived surgery and there was 1 late death at 41 months post-op in an alcoholic
cocaine addict with schizophrenia. No dissection or rupture occurred at a median follow-up of 48
months. Three patients in the retrospective study had peri-operative complications. One with MS
had VF during the closure of the sternum. After defibrillation, the integrity of the origins of the
coronary arteries was confirmed and closure of the chest was completed without incident. A
patient with Loeys-Dietz syndrome developed an asymptomatic but enlarging pseudoaneurysm of
the right coronary artery detected on a routine CT scan and this was successfully repaired. One
patient with MS undergoing mitral valve repair in addition to PEARS had a cardiac arrest on
closure of the sternum. This did not respond to defibrillation and following emergency reinstitution
of CPB, CABG was performed to the circumflex artery and the patient remains well at
follow-up 52 months later. To further investigate the cause of coronary artery injury, a 3D model of
the patient's coronary anatomy was subsequently printed (https://sketchfab.com/3d-models/
p03028-67a0caf20b674d1d8e3cea4b78c2ed46) and compared to the post-operative angiogram
(see image) and confirmed that the main circumflex artery had been occluded by the PEARS graft.
In the pilot study, similar 3D models were created for 6 PEARS patients and used to guide
dissection. All operations were completed with no peri-operative complications and feedback
from the surgeon confirmed the utility of the model.
Conclusions: This pilot study confirms the feasibility of using 3D models of coronary anatomy as
a guide during PEARS surgery and this warrants further study. As some complications such as
coronary artery pseudoaneurysm may be asymptomatic, we recommend routine CT angiograms
be performed within 48 hours of PEARS.
ascending aorta with less than 900 completed worldwide to date. Its proposed advantages over
aortic root replacement include a shorter operation time, retention of the normal aortic valve
leaflets and function and, as there is no prosthetic tissue in contact with the bloodstream, a
reduced lifetime risk of endocarditis. Although in most cases cardiopulmonary bypass (CPB) is not
required, it remains a technically challenging operation that carries a risk of coronary artery
ischaemia requiring emergency intervention. We hypothesised that the incidence of coronary
injury may be reduced by the use of 3D printed models of the coronary artery anatomy as a guide
to the surgeon during dissection and carried out a pilot study.
Methods: A retrospective study was carried out on the first 14 patients in our PEARS programme.
Major complications and duration of follow-up were recorded. A prospective pilot study was
performed using 3D-printed models of the coronary artery anatomy used to guide dissection in 6
consecutive patients.
Results: There was a combined total of 20 patients in the two studies. Their mean age was 37
years (range 17 to 62) and 4 were female. The diagnosis was Marfan syndrome (MS) in 10, Loeys-
Dietz in 3, autosomal dominant connective tissue disorder in 3 and idiopathic in 4. All operations
were completed without the use of CPB, bar two with concomitant mitral valve repair.
All patients survived surgery and there was 1 late death at 41 months post-op in an alcoholic
cocaine addict with schizophrenia. No dissection or rupture occurred at a median follow-up of 48
months. Three patients in the retrospective study had peri-operative complications. One with MS
had VF during the closure of the sternum. After defibrillation, the integrity of the origins of the
coronary arteries was confirmed and closure of the chest was completed without incident. A
patient with Loeys-Dietz syndrome developed an asymptomatic but enlarging pseudoaneurysm of
the right coronary artery detected on a routine CT scan and this was successfully repaired. One
patient with MS undergoing mitral valve repair in addition to PEARS had a cardiac arrest on
closure of the sternum. This did not respond to defibrillation and following emergency reinstitution
of CPB, CABG was performed to the circumflex artery and the patient remains well at
follow-up 52 months later. To further investigate the cause of coronary artery injury, a 3D model of
the patient's coronary anatomy was subsequently printed (https://sketchfab.com/3d-models/
p03028-67a0caf20b674d1d8e3cea4b78c2ed46) and compared to the post-operative angiogram
(see image) and confirmed that the main circumflex artery had been occluded by the PEARS graft.
In the pilot study, similar 3D models were created for 6 PEARS patients and used to guide
dissection. All operations were completed with no peri-operative complications and feedback
from the surgeon confirmed the utility of the model.
Conclusions: This pilot study confirms the feasibility of using 3D models of coronary anatomy as
a guide during PEARS surgery and this warrants further study. As some complications such as
coronary artery pseudoaneurysm may be asymptomatic, we recommend routine CT angiograms
be performed within 48 hours of PEARS.
Aortic Symposium:
Aortic Root
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