[The role of 3D technology in the support of mechanical circulation therapy.] / A 3D technológia szerepe a muszívterápiában.

INTRODUCTION: Successful mechanical circulatory support is influenced by various factors, which are difficult or impossible to control. For ideal functioning of the left ventricular assist device inflow-cannula, its axis should be close to parallel with the septum, facing the mitral valve within the left ventricle. Numerous international publications discuss that deviation from optimal implantation can lead to inadequate functioning and serious complications. OBJECTIVE: Our objective was to developing a method, which, using 3D technology, anatomical and hydrodynamic data, makes optimal surgical implantation of the left ventricular assist device possible. METHOD: Data of 57 patients, receiving mechanical circulatory support at Semmelweis University, Heart and Vascular Center, were analyzed retrospectively. Results of operations performed with the patented novel navigation device (exoskeleton) were compared with results of operations performed conventionally, without navigation (control group). Following pairing based on estimated participation probability, postoperative data of 7-7 patients were compared. DICOM files from CT angiography images were used to create virtual geometries of individual hearts. Optimal inflow-cannula angle was determined through hydrodynamic simulation. Exoskeletons were printed using synthetic resin suitable for surgical purposes. Exoskeleton templates guided punch knife positioning and inflow-cannula implantation. RESULTS: Evaluation of postoperative CT angiography images showed that the angle between inflow-cannula and interventricular septum significantly differed in the exoskeleton and control groups (10.13° ± 2.69° vs. 22.87° ± 12.38°, p = 0.0208). Hydrodynamic tests found significantly lower turbulence in the exoskeleton group. Simulated turbulent kinetic energy was significantly lower in the exoskeleton group, which was 11.7 m2/s2 ± 9.39 m2/s2 vs. 49.59 m2/s2 ± 7.61 m2/s2 on average. CONCLUSION: The results suggest left ventricular assist device implantation with patented exoskeleton to be a standardizable, safe and effective method. Preliminary results suggest, that the method may facilitate individualized care, reduce surgical time and incidence of serious complications. Orv Hetil. 2023; 164(26): 1026-1033.

[Innovation in medicine: opportunities of 3D modeling and printing for perioperative care of cardio and thoracic surgical patients. Experiences in Hungary]. / Innovációs lehetoségek a medicinában: 3D tervezési és 3D nyomtatási lehetoségek a felnott szív- és mellkassebészeti betegellátásban. Magyarországi tapasztalatok.

Use of 3D planning and 3D printing is expanding in healthcare. One of the common applications is the creation of anatomical models for the surgical procedure from DICOM files. These patient-specific models are used for multiple purposes, including visualization of complex anatomical situations, simulation of surgical procedures, patient education and facilitating communication between the different disciplines during clinical case discussions. Cardiac and thoracic surgical applications of this technology development include the use of patient-specific 3D models for exploration of ventricle and aorta function and surgical procedural planning in oncology. The 3D virtual and printed models provide a new visualization perspective for the surgeons and more efficient communication between the different clinical disciplines. The 3D project was started at the Semmelweis University with the cooperation of the Thoracic Surgery Department of the National Institute of Oncology in 2018. The authors want to share their experiences in 3D designed medical tools. Orv Hetil. 2019; 160(50): 1967-1975.

[The Semmelweis University extracorporeal membrane oxygenation program - 5 years' results and perspectives]. / A Semmelweis Egyetem extracorporalis membránoxigenizációs programja ­ az 5 éves Városmajori-eredmények függvényében.

The mechanical circulatory support (MCS) program of the Semmelweis University Heart and Vascular Centre has become established over the last five years. The main requirements of our MCS program to be developed first were the Heart Transplantation and Heart Failure Intensive Care Unit and a well trained medical team. The wide range of mechanical circulatory support devices provides suitable background for the adequate treatment of our patients in all indications. In this review, we present our results related to extracorporeal membrane oxygenation (ECMO) supports performed in the last five years. Between 2012 and 2017, we applied MCS support in 140 cases, among them 111 patients received ECMO support. The leading indications of ECMO support were the following: primary graft failure after heart transplantation (33 cases), postcardiotomy cardiogenic shock (18 patients), acute decompensation of end-stage heart failure (14 patients), acute myocardial infarction complicated with refractory cardiogenic shock (37 patients), cardiogenic shock developed after transcatheter aortic valve implantation (3 patients), malignant arrhythmia due to drug intoxication (1 patient) and acute respiratory distress syndrome (4 cases). The mortality of patients receiving ECMO support was 46%. The analysis of the results of ECMO support needs to change our approach. The mortality results show that we lost the half of our patients. However, the mortality in the conventionally treated patients would have been 100% without ECMO. In fact, we could save the life of half of these patients. Orv Hetil. 2018; 159(46): 1876-1881.

[Computer-assisted decision-making in cardiac surgery: from 3D preoperative planning to computational fluid dynamics in the design of surgical procedures]. / Számítástechnikai döntéstámogató rendszer kiépítése a szívsebészetben: a 3D tervezéstol a posztoperatív eredményekig.

INTRODUCTION: Although surgical specialties utilize static models for preoperative planning, the evolution of dynamic planning methods and computer simulations created the opportunity for the introduction of dynamic parameters in cardiac surgery. Our aim was to apply 3D models in cardiac surgical practice, predicting fluid dynamic results, ventricular shape, volume and function before the operation. METHODS: Using a script developed by us, the raw DICOM files were imported, the dilated left ventricle was modeled and fluid dynamic parameters were simulated, such as flow kinematic and profile analysis, turbulence calculation and myocardial response to shear stress. Then step-by-step simulation of the surgical ventricle restoration procedure was accomplished and the calculated variables were imbedded in silico model. The length of resection lines was modified based on the previous computer simulation and applied during the operation, if feasible. RESULTS: The sphericity and conicity indexes were improved significantly in postoperative period (0.42 vs. 0.67 and 0.36 vs. 0.72, p < 0.05). The occurred shear stress at endocardium decreased 83% due to the normalization of flow kinematic pattern of the ventricle in postoperative period (132.21 ± 29.5 dyne/cm2 vs. 22.92 ± 10.3 p < 0.05 dyne/|cm2). The postoperative turbulent flow pattern significantly decreased, according to our computational method (2712 vs. 1823, p < 0.0001). CONCLUSION: With our method, the standardization of the surgical ventricle reconstruction was achievable and the surgical steps were predictable. Therefore, a new decision making support system was established in cardiac surgery for high risk patients. A personalized surgical technique was offered to our patients, improving their life expectancy and quality of life.

Routine aortic valve replacement followed by a myriad of complications: role of 3D printing in a difficult cardiac surgical case.

Aortic valve replacement (AVR) is a routine cardiac surgical intervention that is rarely associated with severe complications. In this report, we present a complex and unique case following AVR in a middle-aged woman. We show the growing necessity for a strong cooperation between interventional cardiologists and cardiac surgeons, together with the emerging role of cardiac tomography based three-dimensional printing technique in planning and executing precision surgery within the chest.

[Heart transplantation and long-term lvad support cost-effectiveness model]. / Szívtranszplantáció és muszívkezelés költséghatékonysági elemzési modellje.

Heart transplantation is a high priority project at Semmelweis University. In accordance with this, the funding of heart transplantation and mechanical circulatory support also constitutes an important issue. In this report, the authors discuss the creation of a framework with the purpose of comparing the cost-effectiveness of heart transplantation and artificial heart implantation. Our created framework includes the calculation of cost, using the direct allocation method, calculating the incremental cost-effectiveness ratio and creating a cost-effectiveness plane. Using our model, it is possible to compare the initial, perioperative and postoperative expenses of both the transplanted and the artificial heart groups. Our framework can possibly be used for the purposes of long term follow-up and with the inclusion of a sufficient number of patients, the creation of cost-effectiveness analyses and supporting strategic decision-making.

[Migration of an epicardial pacemaker into the abdominal cavity]. / Hasüregbe vándorolt epicardialis pacemaker.

Migration of a permanent pacemaker generator from their intramuscular pocket to the abdominal cavity is a less frequent, but potentially life-threatening complication. The authors present the case of a 69-year-old woman, who visited the emergency department of the clinic, with complains of non-specific abdominal symptoms. Her past medical history included a complete atrioventricular block diagnosed in 2009 during the mitral valve replacement and since then she had an epicardial permanent pacemaker; the pulse generator was placed into an intramuscular pouch created in the left subcostal region. Surprisingly, radiologic examinations showed that the generator migrated into the pouch of Douglas. Considering patient safety, first a new intracardiac pacemaker was implanted and then the migrated device was removed surgically. The patient was discharged on the seventh postoperative day.