The role of 3D printing and finite element-based computational simulations in transcatheter pulmonary valve replacement

Abstract Background. Transcatheter pulmonary valve replacement (TPVR) has emerged as a less invasive alternative to surgical pulmonary valve replacement for patients with right ventricular outflow tract dysfunction, such is especially important for those individuals whom had previous cardiac surgical procedures. Recently, three-dimensional (3D) printing and finite element (FE) computational simulation technologies have been employed to enhance preoperative planning processes; however, their effectiveness and clinical significance remain to be fully validated. This systematic review aims to describe the applications and potential impacts of 3D printing and FE simulation technologies for TPVR in clinical practice. Methods. A systematic search of PubMed, Science Direct, Web of Science, and Google Scholar was conducted to identify studies using patient-specific 3D-printed models and FE simulations for preoperative planning and device performance testing. Results. From 289 identified articles, 28 met the inclusion criteria for this review. The quality assessment of the articles showed that the article selection process was adequate. The eligible studies demonstrated that both 3D printing and FE-based simulations have been primarily used to select the appropriate pulmonary valve size as well as predict the optimal placement; i.e. to avoid potential complications such as paravalvular leakage or pulmonary regurgitation. These technologies are generally used in complex congenital and adult-congenital cases. Additionally, these studies provide valuable insights into the mechanical performances of the transcatheter valves using patient-specific anatomies. Conclusion. 3D-printed models and FE simulations have both demonstrated utilities in TPVR planning; by accurately reproducing a given patient’s anatomy and allowing evaluations of potential device-tissue interactions. These tools thus allow for personalized treatments and also contribute to device innovations and development. Yet, further research in this field is required due to the noted limitations of current studies, including small sample sizes, insufficient standardization, and/or challenges in replicating the biomechanics of cardiac tissue.