CONGRESS ABSTRACT

Objective: In recent decades patients referred for cardiac surgery have dramatically changed.Increase in patient's age and in concomitant comorbidities, have led to signifi cant more complexcases. In order to optimize decision making process and postoperative outcomes, the applicationof modern engineering techniques to the medical fi eld is becoming more and more frequent andwill probably be mandatory in near future. In this study we report a clinical case emblematic ofmultistep co-operation of our division with the engineering department of our University. Materials and Method: A 56 yo female patients suffering from abdominal angina and sincope wasreferred to our division following a CT-diagnosis of interrupted aortic arch and double aneurysmof subclavian arteries (Fig 1A). Following a multidisciplinary meeting to evaluate the optimalsurgical strategy a 4 step engineering protocol was applied: Step 1: Patient-specifi c CT scan postprocessing (Fig 1B) with elaboration of a virtual anatomical model (Fig 1C); Step 2: Rigid patient-specifi c rapid prototype model (Fig 1D); Step 3:Flexible patient-specifi c prototype model (Fig 1E);Step 4: Patient-specifi c computational simulation of pre and postoperative fl ow dynamic (Fig 1F). Results :The proposed protocol allowed us to obtain key answer at each question from eachreconstruction: a) patient-specifi c rigid rapid prototype model was completed including all chest'sstructures, and was used to plan surgical access (Fig 1d). Midline sternotomy appeared to be theonly available surgical access after accurate analysis. A second rapid prototype model (Fig 1e)was obtained in fl exible materials and allowed testing the feasibility of different surgical option.Finally computational analysis was adopted to test the hemodynamic status during the differentphases of surgery (Fig 1f from left to right) and with several size/length of dacron prosthesis.After accurate analysis a size graft n.14 and 15cm length was considered the optimal choice. Conclusion: This anecdotal clinical case represents the optimal didactical summary of medicaland engineering interaction with the common end point of postoperative patients outcome. Ourstudy clearly shows as engineering technologies have to be no longer considerate as additional,decorating tools but have to be accepted as useful and mandatory support to preoperativeplanning of heart surgical procedures to optimize postoperative results.