Scientists are making custom 3D-printed replicas of human hearts in an effort to improve replacement valve procedures, according to a study, which could optimise the lifesaving technology used in thousands of patients annually, reports Bloomberg.
Using scans from 15 patients with aortic stenosis, a narrowing of heart valves that impedes blood flow, researchers from the Massachusetts Institute of Technology, the Cleveland Clinic and other institutions developed a system that mimics blood flow and pressure in individual diseased hearts, suggesting a way to predict the effects of various replacements and select the best fit, avoiding potential leakage and failure.
The approach could have an effect on prosthetic heart valves with a global market worth almost $7bn in 2021 and expected to reach $20bn by 2031 amid an expansion in the older population, said the study authors.
While most replacement valves are designed to mimic those in healthy hearts, the challenge lies in selecting one that fits well in hearts affected by disease, said Luca Rosalia, a graduate student in the MIT-Harvard programme in health sciences and technology who helped write the study, published in Science Robotics.
“No two hearts are the same – there are massive variations among them,” he said, “especially when patients are sick. The advantage of our system is we can recreate not just the form of a patient’s heart, but also its function in both physiology and disease.”
“Valve migration is probably the worst, because you have something inside your heart,” Rosalia said. “That’s extremely dangerous. You would need another surgery to get that removed.”
Leaking valves can also present patients with serious problems, said Ellen Roche, an associate professor at MIT who helped author the study, potentially allowing blood to flow backward in the heart, which can lead to abnormal heart rhythms and other serious consequences.
Doctors commonly treat aortic stenosis by surgically implanting a synthetic valve designed to widen the aorta’s natural valve. In the future, the team says that doctors could potentially use their new procedure to first print a patient’s heart and aorta, then implant a variety of valves into the printed model to see which design results in the best function and fit for that particular patient.
The heart replicas, 3D printed with a soft, elastomeric photopolymer resin, could also be used by research labs and the medical device industry as realistic platforms for testing therapies for various types of heart disease.
Study details
Soft robotic patient-specific hydrodynamic model of aortic stenosis and ventricular remodelling
Luca Rosalia, Caglar Ozturk, Debkalpa Goswami, Jean Bonnemain, Ellen Roche.
Published in Science Robotics on 22 February 2023
Abstract
Aortic stenosis (AS) affects about 1.5 million people in the United States and is associated with a 5-year survival rate of 20% if untreated. In these patients, aortic valve replacement is performed to restore adequate haemodynamics and alleviate symptoms. The development of next-generation prosthetic aortic valves seeks to provide enhanced hemodynamic performance, durability, and long-term safety, emphasising the need for high-fidelity testing platforms for these devices. We propose a soft robotic model that recapitulates patient-specific haemodynamics of AS and secondary ventricular remodelling which we validated against clinical data. The model leverages 3D-printed replicas of each patient’s cardiac anatomy and patient-specific soft robotic sleeves to recreate the patients’ haemodynamics. An aortic sleeve allows mimicry of AS lesions due to degenerative or congenital disease, whereas a left ventricular sleeve recapitulates loss of ventricular compliance and diastolic dysfunction (DD) associated with AS. Through a combination of echocardiographic and catheterisation techniques, this system is shown to recreate clinical metrics of AS with greater controllability compared with methods based on image-guided aortic root reconstruction and parameters of cardiac function that rigid systems fail to mimic physiologically. Last, we leverage this model to evaluate the hemodynamic benefit of transcatheter aortic valves in a subset of patients with diverse anatomies, etiologies, and disease states. Through the development of a high-fidelity model of AS and DD, this work demonstrates the use of soft robotics to recreate cardiovascular disease, with potential applications in device development, procedural planning, and outcome prediction in industrial and clinical settings.
Bloomberg article – Custom 3D-printed hearts offer help for valve replacements (Restricted access)
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