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Demonstration of Use of a Novel 3D Printed Simulator for Mitral Valve Transcatheter Edge-to-Edge Repair (TEER)

Bertolini, Michele; Mullen, Michael; Belitsis, Georgios; Babu, Angel; Colombo, Giorgio; Cook, Andrew; Mullen, Aigerim; (2022) Demonstration of Use of a Novel 3D Printed Simulator for Mitral Valve Transcatheter Edge-to-Edge Repair (TEER). Materials , 15 (12) , Article 4284. 10.3390/ma15124284. Green open access

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Abstract

Mitral regurgitation is a common valvular disorder. Transcatheter edge-to-edge repair (TEER) is a minimally invasive technique which involves holding together the middle segments of the mitral valve leaflets, thereby reducing regurgitation. To date, MitraClip™ is the only Food and Drug Administration (FDA)-approved device for TEER. The MitraClip procedure is technically challenging, characterised by a steep learning curve. Training is generally performed on simplified models, which do not emphasise anatomical features, realistic materials, or procedural scenarios. The aim of this study is to propose a novel, 3D printed simulator, with a major focus on reproducing the anatomy and plasticity of all areas of the heart involved and specifically the ones of the mitral valve apparatus. A three-dimensional digital model of a heart was generated by segmenting computed tomography (CT). The model was subsequently modified for: (i) adding anatomical features not fully visible with CT; (ii) adapting the model to interact with the MitraClip procedural equipment; and (iii) ensuring modularity of the system. The model was manufactured with a Polyjet technology printer, with a differentiated material assignment among its portions. Polypropylene threads were stitched to replicate chordae tendineae. The proposed system was successfully tested with MitraClip equipment. The simulator was assessed to be feasible to practice in a realistic fashion, different procedural aspects including access, navigation, catheter steering, and leaflets grasping. In addition, the model was found to be compatible with clinical procedural imaging fluoroscopy equipment. Future studies will assess the effect of the proposed training system on improving TEER training.

Type: Article
Title: Demonstration of Use of a Novel 3D Printed Simulator for Mitral Valve Transcatheter Edge-to-Edge Repair (TEER)
Location: Switzerland
Open access status: An open access version is available from UCL Discovery
DOI: 10.3390/ma15124284
Publisher version: https://doi.org/10.3390/ma15124284
Language: English
Additional information: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Keywords: mitral valve regurgitation; transcatheter edge-to-edge repair; MitraClip procedure; simulation-based training; segmentation; 3D printing; Polyjet
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science > Childrens Cardiovascular Disease
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
URI: https://discovery.ucl.ac.uk/id/eprint/10150959
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