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a Department of Cardiac Surgery, Ludwig-Maximilian University, Munich, Germany
c Department of Clinical Radiology, Ludwig-Maximilian University, Munich, Germany
b Institute of Micro Technology and Medical Device Technology, Technical University Munich, Garching, Germany
Accepted for publication December 11, 2007.
* Address correspondence to Dr Sodian, Department of Cardiac Surgery, Ludwig-Maximilians-University, Marchioninistr. 15, Munich, 81377, Germany (Email: ralf.sodian{at}med.uni-muenchen.de).
Purpose: Resternotomy for aortic valve replacement in patients with previous coronary artery bypass grafting and an internal mammary artery graft may be a surgical problem. Thus, we are exploring the effect of using rapid prototyping techniques for surgical planning and intraoperative orientation during aortic valve replacement after previous coronary artery bypass grafting (CABG).
Description: As a proof of concept, we studied a patient who had undergone CABG 5 years earlier. At that time the patient received a left internal mammary artery graft to the left anterior descending artery and a venous graft to the right coronary artery. Now the patient required aortic valve replacement due to symptomatic aortic valve stenosis. The left internal mammary artery bypass and the right coronary artery bypass were patent and showed good flow in the angiography. The patient was examined by 128-slice computed tomography. The image data were visualized and reconstructed. Afterwards, a replica showing the anatomic structures was fabricated using a rapid prototyping machine.
Evaluation: Using data derived from 128-slice computed tomography angiography linked to proprietary software, we were able to create three-dimensional reconstructions of the vascular anatomy after the previous CABG. The models were sterilized and taken to the operating theatre for orientation during the surgical procedure.
Conclusions: Stereolithographic replicas are helpful for choosing treatment strategies in surgical planning and for intraoperative orientation during reoperations of patients with previous CABG.
Related Article
Ann. Thorac. Surg. 2008 85: 2108-2109.
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