Three-dimensional printing creates models for surgical planning of aortic valve replacement after previous coronary bypass grafting.
OBJECTIVE
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).


METHODS
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.


RESULTS
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.
Sodian
Ralf
R
Department of Cardiac Surgery, Ludwig-Maximilian University, Munich, Germany. ralf.sodian@med.uni-muenchen.de
Schmauss
Daniel
D
Markert
Mathias
M
Weber
Stefan
S
Nikolaou
Konstantin
K
Haeberle
Sandra
S
Vogt
Ferdinand
F
Vicol
Calin
C
Lueth
Tim
T
Reichart
Bruno
B
Schmitz
Christoph
C
D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D017076:Computer-Aided Design; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D007431:Intraoperative Complications / Q000000981:diagnostic imaging / Q000517:prevention & control; D008953:Models, Anatomic; D009204:Myocardial Revascularization; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000601:surgery*; D011327:Printing; D012984:Software; D036542:Tomography, Spiral Computed; D014680:Veins / Q000637:transplantation