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Wilkat M, Lommen J, Rana M, Kübler N, Wienemann T, Braß SM, Ziegler RT, Mazrekaj A, Knapsis A, Schelzig H, Wagenhäuser MU, Arnautovic A. Accuracy and Sterilizability of In-House Printed Patient-Specific Aortic Model for Surgeon-Modified Stent Grafts-A Workflow Description for Emergency Aortic Endovascular Procedures. J Clin Med 2024; 13:1309. [PMID: 38592134 PMCID: PMC10931993 DOI: 10.3390/jcm13051309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/17/2024] [Accepted: 02/22/2024] [Indexed: 04/10/2024] Open
Abstract
Introduction: The use of 3D-printed aortic models for the creation of surgeon-modified endoprostheses represents a promising avenue in aortic surgery. By focusing on the potential impact of sterilization on model integrity and geometry, this report sheds light on the suitability of these models for creating customized endoprostheses. The study presented here aimed to investigate the safety and viability of 3D-printed aortic models in the context of sterilization processes and subsequent remodeling. Methods: The study involved the fabrication of 3D-printed aortic models using patient-specific imaging data and established additive manufacturing techniques. Five identical aortic models of the same patient were printed. Two models were subjected to sterilization and two to disinfection using commonly employed methods, and one model remained untreated. The models were checked by in-house quality control for deformation (heat map analyses) after the sterilization and disinfection processes. Three models (sterilized, disinfected, and untreated) were sent for ex-house (Lufthansa Technik, AG, Materials Technologies and Central Laboratory Services, Hamburg, Germany) evaluation and subsequent quantification of possible structural changes using advanced imaging and measurement technologies (macroscopic and SEM/EDX examinations). After sterilization and disinfection, each aortic model underwent sterility checks. Results: Based on macroscopic and SEM/EDX examinations, distinct evidence of material alterations attributed to a treatment process, such as a cleaning procedure, was not identified on the three implants. Comparative material analyses conducted via the EDX technique yield consistent results for all three implants. Disinfected and sterilized models tested negative for common pathogens. Conclusions: The evaluation of 3D-printed aortic models' safety after sterilization as well as their suitability for surgeon-modified endoprostheses is a critical step toward their clinical integration. By comprehensively assessing changes in model integrity and geometry after sterilization, this research has contributed to the broader understanding of the use of 3D-printed models for tailor-made endovascular solutions. As medical technologies continue to evolve, research endeavors such as this one can serve as a foundation for harnessing the full potential of 3D printing to advance patient-centered care in aortic surgery.
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Affiliation(s)
- Max Wilkat
- Department for Oral & Maxillofacial Surgery, Medical Faculty and University Hospital Düsseldorf, 40225 Düsseldorf, Germany
| | - Julian Lommen
- Department for Oral & Maxillofacial Surgery, Medical Faculty and University Hospital Düsseldorf, 40225 Düsseldorf, Germany
| | - Majeed Rana
- Department for Oral & Maxillofacial Surgery, Medical Faculty and University Hospital Düsseldorf, 40225 Düsseldorf, Germany
| | - Norbert Kübler
- Department for Oral & Maxillofacial Surgery, Medical Faculty and University Hospital Düsseldorf, 40225 Düsseldorf, Germany
| | - Tobias Wienemann
- Institute of Medical Microbiology and Hospital Hygiene, Medical Faculty and University Hospital Düsseldorf, 40225 Düsseldorf, Germany
| | - Sönke Maximilian Braß
- Department for Vascular and Endovascular Surgery, Medical Faculty and University Hospital Düsseldorf, 40225 Düsseldorf, Germany
| | - Reinhold Thomas Ziegler
- Department for Vascular and Endovascular Surgery, Medical Faculty and University Hospital Düsseldorf, 40225 Düsseldorf, Germany
| | - Agnesa Mazrekaj
- Department for Vascular and Endovascular Surgery, Medical Faculty and University Hospital Düsseldorf, 40225 Düsseldorf, Germany
| | - Artis Knapsis
- Department for Vascular and Endovascular Surgery, Medical Faculty and University Hospital Düsseldorf, 40225 Düsseldorf, Germany
| | - Hubert Schelzig
- Department for Vascular and Endovascular Surgery, Medical Faculty and University Hospital Düsseldorf, 40225 Düsseldorf, Germany
| | - Markus Udo Wagenhäuser
- Department for Vascular and Endovascular Surgery, Medical Faculty and University Hospital Düsseldorf, 40225 Düsseldorf, Germany
| | - Amir Arnautovic
- Department for Vascular and Endovascular Surgery, Medical Faculty and University Hospital Düsseldorf, 40225 Düsseldorf, Germany
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Grillo A, Hyder Z, Mudera V, Kureshi A. Evaluation of hernia surgical meshes sterilised with ethylene oxide for adoption under UK regulations. Surg Endosc 2023; 37:9556-9562. [PMID: 37730855 PMCID: PMC10709235 DOI: 10.1007/s00464-023-10460-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 09/06/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND Low-cost meshes (LCM) have been successfully used in low-income countries (LIC) over the past decades, demonstrating comparable surgical outcomes to commercial meshes at a fraction of the cost. However, LIC sterilisation standards (autoclave sterilisation at 121 °C) do not meet UK regulations for medical devices, which require either ethylene oxide (EO) sterilisation or steam sterilisation at 134 °C. Therefore, the aim of this study was to sterilise UK LCM and characterise their mechanical properties and in vitro biocompatibility to verify whether EO sterilisation causes changes in the mechanical properties and biocompatibility of LCM. METHODS EO sterilised LCM were used. Uniaxial tensile tests were performed to measure mechanical properties. Biocompatibility was measured through viability and morphology of Human Dermal Fibroblasts (HDFs) cultured in mesh-conditioned media, and by calculating the metabolic activity and proliferation of HDFs attached on the meshes, with alamarBlue assay. RESULTS Break stress of LCM1 was significantly higher than LCM2 (p < 0.0001), while Young's modulus of LCM1 was significantly lower than LCM2 (p < 0.05) and there was no significant difference in break strain. Viability and morphology showed no significant difference between LCM and control. Attachment and proliferation of HDFs on LCM showed a better proliferation on LCM2 than LCM1, with values similar to the control at the final time point. CONCLUSIONS We demonstrated that EO sterilisation affects LCM mechanical properties, but they still have values closer to the native tissues than the commercially available ones. We also showed that in vitro biocompatibility of LCM2 is not affected by EO sterilisation, as HDFs attached and proliferated on the mesh, while EO affected attachment on LCM1. A more detailed cost analysis of the potential savings for healthcare systems around the world needs to be performed to strengthen the cost-effectiveness of this frugal innovation.
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Affiliation(s)
- Alessandra Grillo
- Centre for 3D Models of Health and Disease, Division of Surgery & Interventional Science, UCL, London, UK.
| | - Zargham Hyder
- Hydermed Limited, Woodford Green, UK
- Homerton University Hospital, NHS Trust, London, UK
| | - Vivek Mudera
- Centre for 3D Models of Health and Disease, Division of Surgery & Interventional Science, UCL, London, UK
| | - Alvena Kureshi
- Centre for 3D Models of Health and Disease, Division of Surgery & Interventional Science, UCL, London, UK
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Abstract
New developments in additive manufacturing and regenerative medicine have the potential to radically disrupt the traditional pipelines of therapy development and medical device manufacture. These technologies present a challenge for regulators because traditional regulatory frameworks are designed for mass manufactured therapies, rather than bespoke solutions. 3D bioprinting technologies present another dimension of complexity through the inclusion of living cells in the fabrication process. Herein we overview the challenge of regulating 3D bioprinting in comparison to existing cell therapy products as well as custom-made 3D printed medical devices. We consider a range of specific challenges pertaining to 3D bioprinting in regenerative medicine, including classification, risk, standardization and quality control, as well as technical issues related to the manufacturing process and the incorporated materials and cells.
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Affiliation(s)
- Tajanka Mladenovska
- Department of Surgery, St Vincent's Hospital, University of Melbourne, Fitzroy, Victoria, 3065, Australia
- Aikenhead Centre for Medical Discovery (ACMD), St Vincent's Hospital Melbourne, Fitzroy, Victoria, 3065, Australia
| | - Peter F Choong
- Department of Surgery, St Vincent's Hospital, University of Melbourne, Fitzroy, Victoria, 3065, Australia
- Aikenhead Centre for Medical Discovery (ACMD), St Vincent's Hospital Melbourne, Fitzroy, Victoria, 3065, Australia
| | - Gordon G Wallace
- Aikenhead Centre for Medical Discovery (ACMD), St Vincent's Hospital Melbourne, Fitzroy, Victoria, 3065, Australia
- Intelligent Polymer Research Institute, University of Wollongong, Wollongong, New South Wales, 2522, Australia
| | - Cathal D O'Connell
- Department of Surgery, St Vincent's Hospital, University of Melbourne, Fitzroy, Victoria, 3065, Australia
- Aikenhead Centre for Medical Discovery (ACMD), St Vincent's Hospital Melbourne, Fitzroy, Victoria, 3065, Australia
- Discipline of Electrical & Biomedical Engineering, RMIT University, Melbourne, Victoria, 3000, Australia
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Valls-Esteve A, Lustig-Gainza P, Adell-Gomez N, Tejo-Otero A, Englí-Rueda M, Julian-Alvarez E, Navarro-Sureda O, Fenollosa-Artés F, Rubio-Palau J, Krauel L, Munuera J. A state-of-the-art guide about the effects of sterilization processes on 3D-printed materials for surgical planning and medical applications: A comparative study. Int J Bioprint 2023; 9:756. [PMID: 37555083 PMCID: PMC10406103 DOI: 10.18063/ijb.756] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 03/01/2023] [Indexed: 08/10/2023] Open
Abstract
Surgeons use different medical devices in the surgery, such as patient-specific anatomical models, cutting and positioning guides, or implants. These devices must be sterilized before being used in the operation room. There are many sterilization processes available, with autoclave, hydrogen peroxide, and ethylene oxide being the most common in hospital settings. Each method has both advantages and disadvantages in terms of mechanics, chemical interaction, and post-treatment accuracy. The aim of the present study is to evaluate the dimensional and mechanical effect of the most commonly used sterilization techniques available in clinical settings, i.e., Autoclave 121, Autoclave 134, and hydrogen peroxide (HPO), on 11 of the most used 3D-printed materials fabricated using additive manufacturing technologies. The results showed that the temperature (depending on the sterilization method) and the exposure time to that temperature influence not only the mechanical behavior but also the original dimensioning planned on the 3D model. Therefore, HPO is a better overall option for most of the materials evaluated. Finally, based on the results of the study, a recommendation guide on sterilization methods per material, technology, and clinical application is presented.
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Affiliation(s)
- Arnau Valls-Esteve
- Innovation Department, Hospital Sant Joan de Déu,
Esplugues de Llobregat, Spain
- Medicina i Recerca Translacional, Facultat de Medicina i
Ciències de la Salut, Universitat de Barcelona, Spain
- 3D for Health Unit (3D4H), Hospital Sant Joan de
Déu, Universitat de Barcelona, Spain
| | | | - Nuria Adell-Gomez
- Innovation Department, Hospital Sant Joan de Déu,
Esplugues de Llobregat, Spain
- 3D for Health Unit (3D4H), Hospital Sant Joan de
Déu, Universitat de Barcelona, Spain
| | - Aitor Tejo-Otero
- Centre CIM, Universitat Politècnica de Catalunya
(CIM UPC), Barcelona, Spain
| | - Marti Englí-Rueda
- Innovation Department, Hospital Sant Joan de Déu,
Esplugues de Llobregat, Spain
- 3D for Health Unit (3D4H), Hospital Sant Joan de
Déu, Universitat de Barcelona, Spain
| | | | - Osmeli Navarro-Sureda
- Sterilization Department, Hospital Sant Joan de Déu,
Universitat de Barcelona, Spain
| | - Felip Fenollosa-Artés
- Centre CIM, Universitat Politècnica de Catalunya
(CIM UPC), Barcelona, Spain
- Department of Mechanical Engineering, School of Engineering
of Barcelona (ETSEIB), Universitat Politècnica de Catalunya, Barcelona,
Spain
| | - Josep Rubio-Palau
- Medicina i Recerca Translacional, Facultat de Medicina i
Ciències de la Salut, Universitat de Barcelona, Spain
- 3D for Health Unit (3D4H), Hospital Sant Joan de
Déu, Universitat de Barcelona, Spain
- Department of Pediatric Surgery, Hospital Sant Joan de
Déu, Universitat de Barcelona, Spain
- Maxillofacial Unit, Department of Pediatric Surgery,
Hospital Sant Joan de Déu, Universitat de Barcelona, Spain
| | - Lucas Krauel
- Medicina i Recerca Translacional, Facultat de Medicina i
Ciències de la Salut, Universitat de Barcelona, Spain
- 3D for Health Unit (3D4H), Hospital Sant Joan de
Déu, Universitat de Barcelona, Spain
- Department of Pediatric Surgery, Hospital Sant Joan de
Déu, Universitat de Barcelona, Spain
| | - Josep Munuera
- Medicina i Recerca Translacional, Facultat de Medicina i
Ciències de la Salut, Universitat de Barcelona, Spain
- 3D for Health Unit (3D4H), Hospital Sant Joan de
Déu, Universitat de Barcelona, Spain
- Department of Diagnostic Imaging, Hospital Sant Joan de
Déu, Universitat de Barcelona, Spain
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Kantaros A. 3D Printing in Regenerative Medicine: Technologies and Resources Utilized. Int J Mol Sci 2022; 23:ijms232314621. [PMID: 36498949 PMCID: PMC9738732 DOI: 10.3390/ijms232314621] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 11/24/2022] Open
Abstract
Over the past ten years, the use of additive manufacturing techniques, also known as "3D printing", has steadily increased in a variety of scientific fields. There are a number of inherent advantages to these fabrication methods over conventional manufacturing due to the way that they work, which is based on the layer-by-layer material-deposition principle. These benefits include the accurate attribution of complex, pre-designed shapes, as well as the use of a variety of innovative raw materials. Its main advantage is the ability to fabricate custom shapes with an interior lattice network connecting them and a porous surface that traditional manufacturing techniques cannot adequately attribute. Such structures are being used for direct implantation into the human body in the biomedical field in areas such as bio-printing, where this potential is being heavily utilized. The fabricated items must be made of biomaterials with the proper mechanical properties, as well as biomaterials that exhibit characteristics such as biocompatibility, bioresorbability, and biodegradability, in order to meet the strict requirements that such procedures impose. The most significant biomaterials used in these techniques are listed in this work, but their advantages and disadvantages are also discussed in relation to the aforementioned properties that are crucial to their use.
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Affiliation(s)
- Antreas Kantaros
- Department of Industrial Design and Production Engineering, University of West Attica, 12244 Athens, Greece
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Sun Z, Wee C. 3D Printed Models in Cardiovascular Disease: An Exciting Future to Deliver Personalized Medicine. MICROMACHINES 2022; 13:1575. [PMID: 36295929 PMCID: PMC9610217 DOI: 10.3390/mi13101575] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/16/2022] [Accepted: 09/19/2022] [Indexed: 06/16/2023]
Abstract
3D printing has shown great promise in medical applications with increased reports in the literature. Patient-specific 3D printed heart and vascular models replicate normal anatomy and pathology with high accuracy and demonstrate superior advantages over the standard image visualizations for improving understanding of complex cardiovascular structures, providing guidance for surgical planning and simulation of interventional procedures, as well as enhancing doctor-to-patient communication. 3D printed models can also be used to optimize CT scanning protocols for radiation dose reduction. This review article provides an overview of the current status of using 3D printing technology in cardiovascular disease. Limitations and barriers to applying 3D printing in clinical practice are emphasized while future directions are highlighted.
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Affiliation(s)
- Zhonghua Sun
- Discipline of Medical Radiation Science, Curtin Medical School, Curtin University, Perth 6845, Australia
| | - Cleo Wee
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth 6845, Australia
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Initial Experience with Fenestrated Physician-Modified Stent Grafts Using 3D Aortic Templates. J Clin Med 2022; 11:jcm11082180. [PMID: 35456273 PMCID: PMC9027705 DOI: 10.3390/jcm11082180] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 04/07/2022] [Accepted: 04/11/2022] [Indexed: 12/04/2022] Open
Abstract
The goal of this study was to describe the surgical results of physician-modified endografts (PMEG) utilizing a 3D aortic template in a center with no prior experience in complex endovascular aortic repairs. Forty-three patients underwent physician-modified graft stent implantation using a 3D aortic model. The inclusion criteria were juxtarenal and suprarenal aortic aneurysms, type IV thoracoabdominal aneurysms, and type IA endoleak after endovascular aortic repair. In asymptomatic patients, the diameter threshold for aneurysm repair was 5.5 cm in males and 5.0 cm in females. 3D aortic templates were prepared from the patient’s computed tomography angiography scans and sterilized before use in the operating suite. Forty-three stent grafts were modified with the use of a 3D printing template. A total of 162 reinforced fenestrations (37 celiac, 43 right renal, 39 left renal, 43 superior mesenteric) with a mean of 3.8 per patient were performed. All PMEGs had a posterior reducing-diameter tie and a preloaded guidewire. The mean modification time was 86 ± 12 min. The mean follow-up was 14 ± 12 months. The 30-day mortality was 12%. During the follow-up period, the patency rate was 95% per the superior mesenteric artery, 93% per right renal artery, 95% per left renal artery, and 89% per celiac trunk. Twelve (28%) patients had endoleak, of which type I or III was present in 5 (12%) patients, and type II in 7 (16%). 3D printing can be successfully integrated into the physician’s everyday practice of stent graft modification. However, the use of this approach in centers without experience performing complex aortic procedures results in worse surgical metrics than those previously reported.
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