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

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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