A constellation of technological advances helped UR Medicine-led heart specialists save the life of an aging Brighton woman. They used a three-dimensional (3D) print of her heart along with a non-surgical technique to safely replace a failing heart valve.
Surgical device firm LSI Solutions printed a custom, plastic model print of her heart, providing doctors a unique and powerful tool to visualize and plan this delicate procedure.
The woman had multiple heart surgeries previously, including replacement of the aortic and mitral valves, which pump blood through the heart and into the aorta, the largest artery in our bodies. The artificial aortic valve was not working correctly and she faced imminent heart and kidney failure. Doctors at another hospital were unable to provide a solution.
The team of cardiac specialists gathered at Strong Memorial Hospital was challenged to place a new valve within an existing artificial valve. It was an unusual case because artificial valves rarely fail. And, this woman had another artificial valve precariously close to the failing artificial aortic valve.
The heart specialists were concerned about whether the efforts could disturb the mitral valve. They were analyzing a small area of the heart, with vessels just millimeters apart.
Ultrasound and computerized tomography (CT) images of the valves were captured and doctors collaborated with LSI Solutions in Victor to transform those 2D images into a 3D model of the targeted portion of her heart. Doctors used that model to meticulously plan for a transcatheter aortic valve replacement (TAVR), a less invasive method for valve replacement that is only performed at Strong Memorial in the Finger Lakes region.
“This is an amazing advance when you consider the rapid pace of technology and possibilities for the future,” said UR Medicine heart surgeon Peter Knight, M.D., who performed the procedure with interventional cardiologist Thomas Stuver, M.D., of Rochester Cardiopulmonary Group, supported by the UR Medicine Heart & Vascular cardiac catheterization team. Stuver works with UR Medicine specialists on TAVR procedures.
The UR Medicine team may be the leaders in the nation for replacing a valve in a woman’s heart adjacent to the mitral valve.
The uses for 3D printing are expanding and beginning to take hold in medicine. Physicians can use it, as they did at Strong, to visualize procedures in different ways than before and help patients and families better understand the sometimes complex concepts. Medical schools use plastic models for training and scientists hope to someday print replacement body parts.
Jude S. Sauer, M.D., president of LSI, describes “3D printing as the opposite of the way that most things are made today. Traditional part production typically requires the machining away of material from a larger block to yield the desired shape. Think of chipping away at a block of marble to reveal the Statue of David already within. The 3D printing of components involves the precision accumulation of little specks that grow the desired object in empty space,” he said. “These results here were positive for everyone involved.”
A family’s last hope
Murwareed Najim was facing a grim prognosis when doctors at another hospital learned that her artificial aortic valve was not opening and closing properly. Blood didn’t flow smoothly through her heart or body. She was weak, tired and unable to breathe. Two years ago surgeons at that hospital replaced her aortic and mitral valves using traditional surgery.
The 81-year-old woman was simply not strong enough to endure another open heart surgery and her doctors did not expect her to live long.
Mesba Najim was devastated at the possibility of losing his mother and grateful when a nephrologist suggested she may be a candidate for the TAVR procedure. TAVR is a relatively new technique for valve replacement and doesn’t involve open heart surgery. Strong Memorial Hospital introduced this procedure in 2012 and is the only site in the Finger Lakes to offer it.
Stuver met with the family and agreed TAVR was the best treatment for her. The technique allows heart specialists to implant a new collapsible valve through a tiny incision in the groin. A narrow catheter is threaded through the body and into the heart. Once in position, a tiny balloon is inflated to open the new valve and push aside the leaflets of the failed valve. Positive results are immediate.
Najim quickly prepared to transfer his mother to Strong Memorial Hospital for specialty care.
“When we learned there was a treatment that could work for her, of course we pursued it,” Najim said. “We are so happy the doctors were able to save her life and that we have more time with her.”
Stuver and Knight reviewed multiple images of her heart and the artificial valves. They measured the images of the anatomy of her heart and artificial valves. They were concerned about whether placing the new aortic valve could damage or impede the adjacent mitral valve.
Studying the images could not provide enough information, so Knight turned to LSI Solutions’ Sauer, a longtime friend and colleague. A few months ago, the pair was invited to the Mayo Clinic for an innovations conference and one discussion focused on the possibility of using patient-specific 3D printed models to improve surgical outcomes. LSI Solutions uses 3D printing in its device prototype process. However, creating the anatomy of an actual patient’s heart “was a first for us,” Sauer said.
“We brought the scans and digital data together to allow LSI to create the 3D print model of her heart,” Knight said. “We were specifically interested in the relationship of the valves to make sure we had enough room to do the new valve placement inside the old valve. All the pre-operative planning paid off for her.”
The 3D model showed there was plenty of room – measured in millimeters – to place the new aortic valve within the existing aortic valve, without disturbing the mitral valve function, Stuver said.
Preparations moved quickly. The team reviewed the woman’s case on Jan. 5. They captured images of her heart the next day and sent them to LSI Solutions. Sauer’s team began the two-day process of synthesizing the images and creating the model. The heart team successfully placed the new aortic valve within the old valve on Jan. 13. Mrs. Najim’s health immediately improved.
The TAVR procedure was performed just seven days after Mrs. Najim’s arrival at Strong Memorial. “It’s amazing how quickly the whole process moved, but really, we had to do act fast,” Stuver said. “The woman was in pretty bad shape already. It was good to see her return home and to her normal routine, which is our goal.”