Development of an Innovative Pipeline With Fusion, Digital Planning, and Three‐Dimensional Printing to Improve Mitral Valve Interventional Care

Aim
Transesophageal echocardiography (TEE) is the modality of choice for mitral valve (MV) interventional planning. However, computed tomography (CT) has been proposed as a standard screening tool for MV interventions to assess the risk of injury to the left circumflex artery. We aimed to develop a pipeline to fuse CT and MV modalities and create three-dimensional (3D) printable models of the MV apparatus to enhance interventional planning and assessed its usability among clinicians.

Methods and Results
The design, production, and assessment of the 3D-printed personalized models were based on TEE enriched with data from CT. The digital pipeline consisted of fusion with a mutual information algorithm using 3D Slicer (Slicer) and Elastix toolboxes. Flexible 3D printing was performed using Agilus 30 Clear. The pipeline was feasible for achieving semiautomatic fusion of anatomical structures related to MV interventional planning. Visualization of fused synergistic information for 3D planning could be provided in three distinct cases of MV regurgitation (secondary MR with tenting, flail leaflet, and prolapse). The 3D printing resulted in a flexibility in line with actual tissue allowing for tactile modification. An average System Usability Score of 71 indicates a moderately good usability among imaging cardiologists, intervention cardiologists, and cardiac surgeons.

Conclusion
The presented pipeline with digital planning and personalized 3D printing has reached the technology readiness level for application in mitral valve interventions, and prospective clinical trials with endpoints of surgical effectiveness. Comprehensive and efficient interactions between clinicians and technical staff are essential to establish well-designed patient-specific interventions.