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PAR CE QUE LA REUSSISTE DES VOS PROCEDURES INTERVENTIONELLES NOUS IMPORTE
WHO ARE WE?
PAR CE QUE LA REUSSISTE DES VOS PROCEDURES INTERVENTIONELLES NOUS IMPORTE
76 patients (21 patients prospective) 4 centres
Ciobotaru V; EuroIntervention. 2018 March 20;14(2):176-184
Stereolithography 3D Printer
https://www.ncbi.nlm.nih.gov/pubmed/?term=Ciobotaru+V+eurointerventionhttps://www.ncbi.nlm.nih.gov/pubmed/?term=Ciobotaru+V+eurointerventionhttps://www.ncbi.nlm.nih.gov/pubmed/?term=Ciobotaru+V+eurointervention
« LAA-Print Registry »
Unique Protocol ID:* RECHMPL17_0230
Brief Title:* Use lay language. Left Atrial Appendage Occlusion Guided by 3D printing Acronym: LAA-Print registry
Official Title:* National Longitudinal Registry for Mid-Term Clinical Outcome And Procedure Efficacy Evaluation In Using A Novel Preprocedural Planning Method For Left Atrial Appendage Occlusion Guided By 3D Printing
Study Type:* Observational Interventional Expanded access
FDA Regulated Intervention ?* Yes No
IND/IDE Protocol ?* Yes No Secondary ID's: NA
• First prospective study evaluating 3D printing in structural heart (LAAC)
• Large (>200patients), multicentric , (16 centres)
• Clinical aim: to predict procedural risk
• to Improve Safety: by decreasing operating time and complications
Supported by : Boston, Philips, region Occitanie, AG2R fondation
3D Printing Models Enhance Communication with the patients
High Imaging quality
Specific tools for Semiautomated Anatomic segmentation
Off-Line Workstation STL modelling : smoothing, extraction, shell, layers, cutting
Conversion DICOM to STL
MRI or
Signal intensity Contrast Spatial resolution
Materials that can mimic Mechanical properties of human tissue
https://www.google.fr/imgres?imgurl=https%3A%2F%2Fwww.3dnatives.com%2Fwp-content%2Fuploads%2FSLA_Technology.jpg&imgrefurl=https%3A%2F%2Fwww.3dnatives.com%2Flimpression-3d-par-stereolithographie-on-vous-explique-tout%2F&docid=GEt1KxaDOPtCGM&tbnid=jeQp5c2hpGvMyM%3A&vet=10ahUKEwigzPabttLiAhUDNhoKHUgWDI0QMwhRKAAwAA..i&w=850&h=500&bih=963&biw=1920&q=st%C3%A9r%C3%A9olithographie%20imprimante%203d&ved=0ahUKEwigzPabttLiAhUDNhoKHUgWDI0QMwhRKAAwAA&iact=mrc&uact=8https://www.google.fr/imgres?imgurl=https%3A%2F%2Fcdn-reichelt.de%2Fbilder%2Fweb%2Fxxl_ws%2FE400%2FFORMLABS_FORM2_01.png&imgrefurl=https%3A%2F%2Fwww.reichelt.com%2Fde%2Ffr%2Fimprimante-3d-avec-la-technologie-de-st-r-olithographie-form-2-p160425.html&docid=NmOtHZuqe-l6PM&tbnid=Vp4Xwvtc4gpZCM%3A&vet=10ahUKEwigzPabttLiAhUDNhoKHUgWDI0QMwhbKAowCg..i&w=2159&h=2905&bih=963&biw=1920&q=st%C3%A9r%C3%A9olithographie%20imprimante%203d&ved=0ahUKEwigzPabttLiAhUDNhoKHUgWDI0QMwhbKAowCg&iact=mrc&uact=8https://www.google.fr/imgres?imgurl=http%3A%2F%2Fwww.3darcwest.com%2Fimages%2F3darcwest%2Ftechnologies%2Fobjet%2Fpolyjet%2Fpolyjet_print_head_drawing.ashx.jpeg&imgrefurl=http%3A%2F%2Fwww.3darcwest.com%2Fcomponent%2Fk2%2Fitem%2F22-technologies-a-jets-de-matiere-objet-polyjet.html&docid=DfvTY0AI1dFKQM&tbnid=b6vmkE76JZ3jXM%3A&vet=10ahUKEwiw7dqJt9LiAhVHhxoKHeOyABEQMwiBASgsMCw..i&w=200&h=159&bih=855&biw=1200&q=polyjet%20imprimante%203d&ved=0ahUKEwiw7dqJt9LiAhVHhxoKHeOyABEQMwiBASgsMCw&iact=mrc&uact=8https://www.google.fr/imgres?imgurl=https%3A%2F%2Fwww.cadvision.fr%2Fsites%2Fall%2Ffiles%2Fstyles%2Fmachine_images%2Fpublic%2Fimages%2Fimprimantes-3d%2Fmachines%2Fj750%2Fimprimante-3d-j750-stratasys.jpg%3Fitok%3DFtze0fwW&imgrefurl=https%3A%2F%2Fwww.cadvision.fr%2Fimprimante-3d%2Fimprimantes-3d-j750-j735&docid=k-ppXXaP2f9UxM&tbnid=r8WXqhiUtFGVqM%3A&vet=10ahUKEwiw7dqJt9LiAhVHhxoKHeOyABEQMwhYKBEwEQ..i&w=1289&h=1000&bih=855&biw=1200&q=polyjet%20imprimante%203d&ved=0ahUKEwiw7dqJt9LiAhVHhxoKHeOyABEQMwhYKBEwEQ&iact=mrc&uact=8https://www.google.fr/imgres?imgurl=https%3A%2F%2Fwww.kallisto.net%2F54-large_default%2Fimprimante-3d-sls-production-additive-spro-140.jpg&imgrefurl=https%3A%2F%2Fwww.kallisto.net%2Ffrittage-laser-sls%2F57-imprimante-3d-sls-production-additive-spro-140.html&docid=JfntRnfquQMHVM&tbnid=GjEEOic8Gd0h6M%3A&vet=10ahUKEwibrfLft9LiAhUSCRoKHWaLCeIQMwiPASg6MDo..i&w=458&h=458&bih=855&biw=1200&q=SLS%20imprimante%203d&ved=0ahUKEwibrfLft9LiAhUSCRoKHWaLCeIQMwiPASg6MDo&iact=mrc&uact=8https://www.google.fr/imgres?imgurl=http%3A%2F%2Fwww.formation-3d-france.com%2Fwp-content%2Fuploads%2F2014%2F08%2FSLS.jpg&imgrefurl=http%3A%2F%2Fwww.formation-3d-france.com%2Fimpression-3d-brevets-sls%2F&docid=8xBdliSBq7EgtM&tbnid=SFBVmS0LGZIoUM%3A&vet=10ahUKEwibrfLft9LiAhUSCRoKHWaLCeIQMwiHASgyMDI..i&w=1000&h=700&bih=855&biw=1200&q=SLS%20imprimante%203d&ved=0ahUKEwibrfLft9LiAhUSCRoKHWaLCeIQMwiHASgyMDI&iact=mrc&uact=8
CASE STUDIES
Après atriotomie droite INSPECTION
Distance tricuspide-AP suffisante Pas d’anomalie valvulaire AV
TUNNELISATION POSSIBLE + Elargissement CIV
RESULTAT : Voies de sortie OK
A Metras, E Fournier, N Tafer, X Iriart, F
Roubertie, LA Arsac, B Kreitmann
CHU BordeauxCHU La Réunion
Journées d’automne 2018 Société Française de Chirurgie Thoracique
Valve in MAC: strategy, device testing: Polyjet multi-material 3D Printer
Percutaneous pulmonary valve implantation in large right ventricular outflow tract
STL model
Patient balloon sizing 3D model simulation
X1
X3
X4
X2
Dr S Hascoet Hospital MLLGData from “Pulmonary-Print» registry/ ABSTRACT submitted FCPC2019 Tours
3DTEE pre-proceduralCT pre-procedural
Modified protocol High spatial resolution: pitch, FOV, reduce metal artefact
High 3D Imaging frame, In face vieux
Serial testing : AVPII, ASD, PDA, AVPIII
Operators: Dr Victor Tadros Dr Sebastien Armero Dr Vlad Ciobotaru
Alignment Implantation AVP3
Check leaflet Adjustment
Simulation Vascular Plug 3
Post Procedural CT
Operators: Dr Victor Tadros Dr Sebastien Armero Dr Vlad Ciobotaru
13h12 13h40
“FFPP-Print” Registry
Pre-tested 3D printing Choice
Implanted Removed Final Choice
Time
Case 1 PVL Mitral
AVPII, ASD, PDA, AVPIII 10/14
AVPIII AVPIII 12mm 0 AVPIII 57min
Case 2 PVL Mitral
AVPII AVPIII 9/14 ASD
AVPIII AVPIII +AVPII ASD AVPIII+ AVPII 10/12mm
100min
Case 3 PVL Aortic
AVPIIAVPIII 10/14 none AVPIII 10/14 AVPIII14 AVPIII Emergency surgery: disc blocked
105min
Case 4 IVC postTAVI
AVPIII AVPII VSD8/12/16mm
VSD16mm VSD8mm 16mm
VSD8mm VSD16mm 90min
Case 5 PVL Aortic
AVPII 8/12mm AVPII AVPII 0 AVPII 50min
FFPP-Print Registry
https://www.google.fr/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&ved=2ahUKEwis_vH_ntDiAhVG6Z8KHSYhBwYQjRx6BAgBEAU&url=http%3A%2F%2Fwww.medicalexpo.com%2Fprod%2Fst-jude-medical%2Fproduct-70886-518144.html&psig=AOvVaw3gP7QLP_7TTsV8UlNTKWcY&ust=1559751845906581https://www.google.fr/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&ved=2ahUKEwis_vH_ntDiAhVG6Z8KHSYhBwYQjRx6BAgBEAU&url=http%3A%2F%2Fwww.medicalexpo.com%2Fprod%2Fst-jude-medical%2Fproduct-70886-518144.html&psig=AOvVaw3gP7QLP_7TTsV8UlNTKWcY&ust=1559751845906581https://www.google.fr/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&ved=2ahUKEwis_vH_ntDiAhVG6Z8KHSYhBwYQjRx6BAgBEAU&url=http%3A%2F%2Fwww.medicalexpo.com%2Fprod%2Fst-jude-medical%2Fproduct-70886-518144.html&psig=AOvVaw3gP7QLP_7TTsV8UlNTKWcY&ust=1559751845906581https://www.google.fr/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&ved=2ahUKEwis_vH_ntDiAhVG6Z8KHSYhBwYQjRx6BAgBEAU&url=http%3A%2F%2Fwww.medicalexpo.com%2Fprod%2Fst-jude-medical%2Fproduct-70886-518144.html&psig=AOvVaw3gP7QLP_7TTsV8UlNTKWcY&ust=1559751845906581
CD
TC
CD
TC
TC
Reduced valsava right sinus
CD
Reduced Height of Right coronary ostium
Risk of coronary obstruction post TAVI, predicted by 3D printed model
CDTC
Medtronic EvolutR N°26
Check For Implantation
depth
Coronary neosinus Right neosinus quasi inexistant !!
3DPrinting in predicting coronary obstruction by TAVI
Retroperfusion of Right Coronary
Perfusion mark on the covering skirt below the leaflet
insertion Conclusion: TAVR Medtronic Evolut 26
Induce right coronary obstruction
Présentation filiale d’écho JESFC2019
OUR STRENGTHS
3DPrinting ongoing development: Co-development : Software for STL tools: 3D model ISP10 Philips
10
Data flux secured
HostData Center
HEGP Creteil MarieLanlongue Bordeaux Grenoble Toulouse Marseille Nice Nîmes
CCN Ambroise Paré Lille Amiens Rouen Timone Millenaire
AVPII Testing
AVPIII Testing
Conclusion: The key of a better treatment is anticipation
• Percutaneous procedures are going to increase and need multi modality imaging :
• However, uncertainty may exist in Decision-making process or planning. • 3D-printed patient-specific adaptive and flexible models improve device
sizing, by incorporating all anatomical variations.
• the use of 3D models permits critical preprocedural planning of the optimal procedure. This can potentially lead to improved patient outcomes.
• 3D printing allows a real time devices testing (high predictive value)
PEOPLE WHO TRUST US
AWARDS
Prix « recherche et innovation » de la SFC2019 pour l applicabilité de 3D printing en cardiologie
premier prix « e-cardiology » ESC2017 Barcelone
Cardio-Interventionals
Conclusion: 3D printing leads to a paradigm shift in operating process
Multi-modality Imagingvisualisation
3D Printing
SIMULATION real TESTING
PAR CE QUE LA REUSSISTE DES VOS PROCEDURES INTERVENTIONELLES NOUS IMPORTE
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