Feasibility of 3-dimensional printed models in simulated training and teaching of transcatheter aortic valve replacement

Figures

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  Figure 1. The main process of 3D-printed aortic root models.

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  Figure 2. The 3D-printed aortic root models and pulsatile simulators. (a) The pulsatile simulators for TAVR via the peripheral artery approach. (b) The pulsatile simulators for TAVR via the apex approach. (c) The 3D-printed aorta model used for crossing-valve simulation. (d) The driving segment of the TAVR pulsatile simulator. Yellow arrows indicate the detachable 3D-printed aortic root model. 3D, 3-dimensional; TAVR, transcatheter aortic valve replacement.

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  Figure 3. Simulation training using 3D-printed aortic root models and pulsatile simulators. (a and b) The simulation using different balloon sizes to observe the changes in leaflets and calcification. (c) Preprocedural simulations using the 3D-printed aortic root model to predict paravalvular leakage. (d) Preprocedural simulations using the 3D-printed aortic root model to predict conduct blockage. (e) Trainees simulated TAVR using the pulsatile simulator. (f) Balloon expansion was simulated using a pulsatile simulator via a peripheral artery approach. 3D, 3-dimensional; TAVR, transcatheter aortic valve replacement.

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  Figure 4. Simulation training on the bench test. (a) The pulsatile simulator was prepared for TAVR simulation. (b) The proceduralist was training the procedural step of crossing the valve. (c) The proceduralist was training the procedural step of stent release. (d) The stent was positioned precisely in the DSA image. (e) The stent was released in the DSA image. (f) After the stent was released, the DSA image showed that the stent attached well to the 3D-printed model. TAVR, transcatheter aortic valve replacement; DSA, digital subtracted angiography; 3D, 3-dimensional.

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  Figure 5. The flowchart of this study. (a) The 6 proceduralists in non-3D-printed simulation group conducted routine 2-dimensional imaging assessment before TAVR and the 6 proceduralists in 3D-printed simulation group completed three steps of simulations successively before TAVR. (b) The expert group (n = 10) and the young proceduralist group (n = 10) both completed 3 times of simulations on the pulsatile simulator. (c) All 32 proceduralists filled out the questionnaire.

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  Figure 6. The outcomes of TAVR simulations. (a) The comparison of crossing-valve time between the 3D-printed simulation group and the non-3D-printed simulation group (P < 0.001). (b) Comparison of the total time between the 3D-printed simulation group and the non-3D-printed simulation group (P < 0.001). (c) The comparison of crossing-valve time between three simulations in the expert group (P < 0.001). (d) The comparison of total time between three simulations in the expert group (P < 0.001). (e) The comparison of crossing-valve time between three simulations in the young proceduralist group (P < 0.001). (f) The comparison of total time between three simulations in the young proceduralist group (P < 0.001). P value from paired Student’s t test. TAVR, transcatheter aortic valve replacement; 3D, 3-dimensional.