Intraoperative Use of Computer-Aided 3D Printed Exoskeleton Supporting Left Ventricular Assist Device Implantation

Purpose We aimed to establish a 3D guiding model which can provide the proper position of the LVAD during surgical implantation with the prediction of the changes of fluid dynamical pattern inside the left ventricle. We want to describe a simple, reproducible technique for implanting LVAD to ensure proper positioning, which improve results in the postoperative period. Methods A personalized 3D heart model was created for left ventricular assist device implantation, using CT angiography scans. This step ensures the accurate anatomical position of the inflow cannula (IC). The next step is the flow simulation where the fine adjustment of IC placement was predicted, using computational fluid dynamical modeling. In silico 50 different inflow cannula angles were adjusted and simulated the changes of the left ventricle flow pattern in every angle. The angle corresponding to the best intraventricular flow patter was selected from the 50 simulation results. When we know the proper anatomical position and angle of the IC, a personalized 3D exoskeleton was planned on the virtual surface of the patient's heart. Consequently, the simulation coordinates were transferred to 3D printed surgical guiding exoskeleton. In operation room, the exoskeleton was placed on the surface of the heart to guide the coring procedure during LVAD implantation. The coring knife was slipped in the coring guiding tube. After the coring procedure, the LVAD was implanted routinely. Results Since 2018 twelve implantations were performed utilizing our patent with no incidences of inflow cannula misplacement, thrombosis, stroke and right heart failure due to inaccurate IC position. Comparing the planned and the actual postoperative angles of the implanted devices inflow cannula, a significant difference was not shown. It proves that the surgical implementation of the calculation was excellent during the operation, using the 3D printed surgical guiding exoskeleton. Conclusion With our method, the standardization of the apex coring and IC positionoing during LVAD implantation was achievable, and the surgical steps were predictable. Therefore, a new decision-making support system was established in cardiac surgery, improving implantation success. The described technique is simple, easily reproducible, and accurate. The exoskeleton is patent filed, the pending patent number: P1800379.