par ce que la reussiste des vos procedures ...operators: dr victor tadros dr sebastien armero dr...
TRANSCRIPT
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PAR CE QUE LA REUSSISTE DES VOS PROCEDURES INTERVENTIONELLES NOUS IMPORTE
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WHO ARE WE?
PAR CE QUE LA REUSSISTE DES VOS PROCEDURES INTERVENTIONELLES NOUS IMPORTE
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76 patients (21 patients prospective) 4 centres
Ciobotaru V; EuroIntervention. 2018 March 20;14(2):176-184
Stereolithography 3D Printer
https://www.ncbi.nlm.nih.gov/pubmed/?term=Ciobotaru+V+eurointerventionhttps://www.ncbi.nlm.nih.gov/pubmed/?term=Ciobotaru+V+eurointerventionhttps://www.ncbi.nlm.nih.gov/pubmed/?term=Ciobotaru+V+eurointervention
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« LAA-Print Registry »
Unique Protocol ID:* RECHMPL17_0230
Brief Title:* Use lay language. Left Atrial Appendage Occlusion Guided by 3D printing Acronym: LAA-Print registry
Official Title:* National Longitudinal Registry for Mid-Term Clinical Outcome And Procedure Efficacy Evaluation In Using A Novel Preprocedural Planning Method For Left Atrial Appendage Occlusion Guided By 3D Printing
Study Type:* Observational Interventional Expanded access
FDA Regulated Intervention ?* Yes No
IND/IDE Protocol ?* Yes No Secondary ID's: NA
• First prospective study evaluating 3D printing in structural heart (LAAC)
• Large (>200patients), multicentric , (16 centres)
• Clinical aim: to predict procedural risk
• to Improve Safety: by decreasing operating time and complications
Supported by : Boston, Philips, region Occitanie, AG2R fondation
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3D Printing Models Enhance Communication with the patients
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High Imaging quality
Specific tools for Semiautomated Anatomic segmentation
Off-Line Workstation STL modelling : smoothing, extraction, shell, layers, cutting
Conversion DICOM to STL
MRI or
Signal intensity Contrast Spatial resolution
Materials that can mimic Mechanical properties of human tissue
https://www.google.fr/imgres?imgurl=https%3A%2F%2Fwww.3dnatives.com%2Fwp-content%2Fuploads%2FSLA_Technology.jpg&imgrefurl=https%3A%2F%2Fwww.3dnatives.com%2Flimpression-3d-par-stereolithographie-on-vous-explique-tout%2F&docid=GEt1KxaDOPtCGM&tbnid=jeQp5c2hpGvMyM%3A&vet=10ahUKEwigzPabttLiAhUDNhoKHUgWDI0QMwhRKAAwAA..i&w=850&h=500&bih=963&biw=1920&q=st%C3%A9r%C3%A9olithographie%20imprimante%203d&ved=0ahUKEwigzPabttLiAhUDNhoKHUgWDI0QMwhRKAAwAA&iact=mrc&uact=8https://www.google.fr/imgres?imgurl=https%3A%2F%2Fcdn-reichelt.de%2Fbilder%2Fweb%2Fxxl_ws%2FE400%2FFORMLABS_FORM2_01.png&imgrefurl=https%3A%2F%2Fwww.reichelt.com%2Fde%2Ffr%2Fimprimante-3d-avec-la-technologie-de-st-r-olithographie-form-2-p160425.html&docid=NmOtHZuqe-l6PM&tbnid=Vp4Xwvtc4gpZCM%3A&vet=10ahUKEwigzPabttLiAhUDNhoKHUgWDI0QMwhbKAowCg..i&w=2159&h=2905&bih=963&biw=1920&q=st%C3%A9r%C3%A9olithographie%20imprimante%203d&ved=0ahUKEwigzPabttLiAhUDNhoKHUgWDI0QMwhbKAowCg&iact=mrc&uact=8https://www.google.fr/imgres?imgurl=http%3A%2F%2Fwww.3darcwest.com%2Fimages%2F3darcwest%2Ftechnologies%2Fobjet%2Fpolyjet%2Fpolyjet_print_head_drawing.ashx.jpeg&imgrefurl=http%3A%2F%2Fwww.3darcwest.com%2Fcomponent%2Fk2%2Fitem%2F22-technologies-a-jets-de-matiere-objet-polyjet.html&docid=DfvTY0AI1dFKQM&tbnid=b6vmkE76JZ3jXM%3A&vet=10ahUKEwiw7dqJt9LiAhVHhxoKHeOyABEQMwiBASgsMCw..i&w=200&h=159&bih=855&biw=1200&q=polyjet%20imprimante%203d&ved=0ahUKEwiw7dqJt9LiAhVHhxoKHeOyABEQMwiBASgsMCw&iact=mrc&uact=8https://www.google.fr/imgres?imgurl=https%3A%2F%2Fwww.cadvision.fr%2Fsites%2Fall%2Ffiles%2Fstyles%2Fmachine_images%2Fpublic%2Fimages%2Fimprimantes-3d%2Fmachines%2Fj750%2Fimprimante-3d-j750-stratasys.jpg%3Fitok%3DFtze0fwW&imgrefurl=https%3A%2F%2Fwww.cadvision.fr%2Fimprimante-3d%2Fimprimantes-3d-j750-j735&docid=k-ppXXaP2f9UxM&tbnid=r8WXqhiUtFGVqM%3A&vet=10ahUKEwiw7dqJt9LiAhVHhxoKHeOyABEQMwhYKBEwEQ..i&w=1289&h=1000&bih=855&biw=1200&q=polyjet%20imprimante%203d&ved=0ahUKEwiw7dqJt9LiAhVHhxoKHeOyABEQMwhYKBEwEQ&iact=mrc&uact=8https://www.google.fr/imgres?imgurl=https%3A%2F%2Fwww.kallisto.net%2F54-large_default%2Fimprimante-3d-sls-production-additive-spro-140.jpg&imgrefurl=https%3A%2F%2Fwww.kallisto.net%2Ffrittage-laser-sls%2F57-imprimante-3d-sls-production-additive-spro-140.html&docid=JfntRnfquQMHVM&tbnid=GjEEOic8Gd0h6M%3A&vet=10ahUKEwibrfLft9LiAhUSCRoKHWaLCeIQMwiPASg6MDo..i&w=458&h=458&bih=855&biw=1200&q=SLS%20imprimante%203d&ved=0ahUKEwibrfLft9LiAhUSCRoKHWaLCeIQMwiPASg6MDo&iact=mrc&uact=8https://www.google.fr/imgres?imgurl=http%3A%2F%2Fwww.formation-3d-france.com%2Fwp-content%2Fuploads%2F2014%2F08%2FSLS.jpg&imgrefurl=http%3A%2F%2Fwww.formation-3d-france.com%2Fimpression-3d-brevets-sls%2F&docid=8xBdliSBq7EgtM&tbnid=SFBVmS0LGZIoUM%3A&vet=10ahUKEwibrfLft9LiAhUSCRoKHWaLCeIQMwiHASgyMDI..i&w=1000&h=700&bih=855&biw=1200&q=SLS%20imprimante%203d&ved=0ahUKEwibrfLft9LiAhUSCRoKHWaLCeIQMwiHASgyMDI&iact=mrc&uact=8
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CASE STUDIES
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Après atriotomie droite INSPECTION
Distance tricuspide-AP suffisante Pas d’anomalie valvulaire AV
TUNNELISATION POSSIBLE + Elargissement CIV
RESULTAT : Voies de sortie OK
A Metras, E Fournier, N Tafer, X Iriart, F
Roubertie, LA Arsac, B Kreitmann
CHU BordeauxCHU La Réunion
Journées d’automne 2018 Société Française de Chirurgie Thoracique
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Valve in MAC: strategy, device testing: Polyjet multi-material 3D Printer
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Percutaneous pulmonary valve implantation in large right ventricular outflow tract
STL model
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Patient balloon sizing 3D model simulation
X1
X3
X4
X2
Dr S Hascoet Hospital MLLGData from “Pulmonary-Print» registry/ ABSTRACT submitted FCPC2019 Tours
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3DTEE pre-proceduralCT pre-procedural
Modified protocol High spatial resolution: pitch, FOV, reduce metal artefact
High 3D Imaging frame, In face vieux
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Serial testing : AVPII, ASD, PDA, AVPIII
Operators: Dr Victor Tadros Dr Sebastien Armero Dr Vlad Ciobotaru
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Alignment Implantation AVP3
Check leaflet Adjustment
Simulation Vascular Plug 3
Post Procedural CT
Operators: Dr Victor Tadros Dr Sebastien Armero Dr Vlad Ciobotaru
13h12 13h40
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“FFPP-Print” Registry
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Pre-tested 3D printing Choice
Implanted Removed Final Choice
Time
Case 1 PVL Mitral
AVPII, ASD, PDA, AVPIII 10/14
AVPIII AVPIII 12mm 0 AVPIII 57min
Case 2 PVL Mitral
AVPII AVPIII 9/14 ASD
AVPIII AVPIII +AVPII ASD AVPIII+ AVPII 10/12mm
100min
Case 3 PVL Aortic
AVPIIAVPIII 10/14 none AVPIII 10/14 AVPIII14 AVPIII Emergency surgery: disc blocked
105min
Case 4 IVC postTAVI
AVPIII AVPII VSD8/12/16mm
VSD16mm VSD8mm 16mm
VSD8mm VSD16mm 90min
Case 5 PVL Aortic
AVPII 8/12mm AVPII AVPII 0 AVPII 50min
FFPP-Print Registry
https://www.google.fr/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&ved=2ahUKEwis_vH_ntDiAhVG6Z8KHSYhBwYQjRx6BAgBEAU&url=http%3A%2F%2Fwww.medicalexpo.com%2Fprod%2Fst-jude-medical%2Fproduct-70886-518144.html&psig=AOvVaw3gP7QLP_7TTsV8UlNTKWcY&ust=1559751845906581https://www.google.fr/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&ved=2ahUKEwis_vH_ntDiAhVG6Z8KHSYhBwYQjRx6BAgBEAU&url=http%3A%2F%2Fwww.medicalexpo.com%2Fprod%2Fst-jude-medical%2Fproduct-70886-518144.html&psig=AOvVaw3gP7QLP_7TTsV8UlNTKWcY&ust=1559751845906581https://www.google.fr/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&ved=2ahUKEwis_vH_ntDiAhVG6Z8KHSYhBwYQjRx6BAgBEAU&url=http%3A%2F%2Fwww.medicalexpo.com%2Fprod%2Fst-jude-medical%2Fproduct-70886-518144.html&psig=AOvVaw3gP7QLP_7TTsV8UlNTKWcY&ust=1559751845906581https://www.google.fr/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&ved=2ahUKEwis_vH_ntDiAhVG6Z8KHSYhBwYQjRx6BAgBEAU&url=http%3A%2F%2Fwww.medicalexpo.com%2Fprod%2Fst-jude-medical%2Fproduct-70886-518144.html&psig=AOvVaw3gP7QLP_7TTsV8UlNTKWcY&ust=1559751845906581
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CD
TC
CD
TC
TC
Reduced valsava right sinus
CD
Reduced Height of Right coronary ostium
Risk of coronary obstruction post TAVI, predicted by 3D printed model
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CDTC
Medtronic EvolutR N°26
Check For Implantation
depth
Coronary neosinus Right neosinus quasi inexistant !!
3DPrinting in predicting coronary obstruction by TAVI
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Retroperfusion of Right Coronary
Perfusion mark on the covering skirt below the leaflet
insertion Conclusion: TAVR Medtronic Evolut 26
Induce right coronary obstruction
Présentation filiale d’écho JESFC2019
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OUR STRENGTHS
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3DPrinting ongoing development: Co-development : Software for STL tools: 3D model ISP10 Philips
10
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Data flux secured
HostData Center
HEGP Creteil MarieLanlongue Bordeaux Grenoble Toulouse Marseille Nice Nîmes
CCN Ambroise Paré Lille Amiens Rouen Timone Millenaire
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AVPII Testing
AVPIII Testing
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Conclusion: The key of a better treatment is anticipation
• Percutaneous procedures are going to increase and need multi modality imaging :
• However, uncertainty may exist in Decision-making process or planning. • 3D-printed patient-specific adaptive and flexible models improve device
sizing, by incorporating all anatomical variations.
• the use of 3D models permits critical preprocedural planning of the optimal procedure. This can potentially lead to improved patient outcomes.
• 3D printing allows a real time devices testing (high predictive value)
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PEOPLE WHO TRUST US
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AWARDS
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Prix « recherche et innovation » de la SFC2019 pour l applicabilité de 3D printing en cardiologie
premier prix « e-cardiology » ESC2017 Barcelone
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Cardio-Interventionals
Conclusion: 3D printing leads to a paradigm shift in operating process
Multi-modality Imagingvisualisation
3D Printing
SIMULATION real TESTING
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PAR CE QUE LA REUSSISTE DES VOS PROCEDURES INTERVENTIONELLES NOUS IMPORTE