INTERVIEW
3D Printing: Mapping
the Way for Device
Placement in Adults
with Congenital
Heart Disease
An Interview with Ulrich Jorde, MD
Patients with congenital heart disease present a number of unique challenges for heart surgeons. Advances in 3D printing technology could
be poised to play a supporting role in ventricular
assist device placement for these patients. A
recent JACC: Heart Failure study explores this
idea further. In this interview from ACC.16 in
Chicago, CSWN Executive Editor Rick McGuire
talks with paper co-author Ulrich P. Jorde, MD,
section head of the heart failure cardiac transplantation and mechanical circulatory support at
Montefiore Medical Center, New York City, NY.
CSWN: This is a fun topic. We did a cover
story on 3D printing 1 year ago, and this just
seems to be an ideal setting for it.
Ulrich P. Jorde, MD: I think so, too. This is a
very exciting time because two things are converging. First, we have a lot more patients (unfortunate patients with congenit al heart disease),
who, in the past, used to simply die.
Nowadays, through great advances in diagnosis and surgical maneuvering, [these patients]
see their life lengthened. At this moment in time,
there are actually more adult congenital heart patients than children, and these patients, unfortunately, will develop congestive heart failure (HF).
In comes mechanical circulatory support, evolved
over the past decades from large, bulky, clunky
pumps to now very small, golf-ball-size mechanical circulatory-support devices that can be used
in these patients.
Congenital heart disease patients pose
unique challenges, as the anatomy is completely
different from a regular mechanical-support
patient. In the regular mechanical circulatory
support (MCS) world, we have learned to illustrate the issues, the extreme importance of plac-
36 CardioSource WorldNews
Ulrich P. Jorde, MD
ing the device in the right spot, and placing the
cannula within the normal left ventricule (which
is dilated) in the right spot. You can imagine how,
in congenital heart disease, this is a much bigger
challenge.
A typical example would be a situation
where the right ventricle, which is more heavily trabeculated than the left, has become the
systemic ventricle, yet needs to support systemic
circulation. Here, regular insertion of a cannula
will basically embed the cannula in trabeculations. There are few cases where this has been
done, and the surgeons have had a learning curve
where they now know to cut away some of the
trabeculations to put in the cannula. But this is
just the very beginning.
Now we’re moving from transposition of
the great artery cases that are fairly straight forward with the right ventricle to situations with
a Fontan circulation, for example, where the patient has had two or three surgeries in the past
and now the pump is failing. In these patients,
what we have done (and reported in our paper)
is to [create] 3D-printed hearts with all their
June 2016