Washington University in St. Louis, affiliated with St. Louis Children's Hospital, BJC Healthcare, recognized as one of America's top children's hospitals in all ten specialties served by U.S. News & World Report, announced the March 9th launch of its 3D printing center. The goal of the center, based in St. Louis Children’s Hospital, is to help physicians and researchers advance the use of 3D printing for a wide range of clinical, educational, and research applications in pediatric and adult patients. On site are a Stratasys J750 and Eden printers to make patient-specific models for surgical planning and to enhance clinical education, training, and research.
Shafkat Anwar, MD
As the print center opens its doors, we were fortunate to sit down with Shafkat Anwar, M.D., Cardiology Director, Cardiac MRI and Co- Director of the 3D Printing Center at Washington University Medical Campus, to discuss his center’s experience with 3D printing and the impact it has had on the patients, the families, and the medical community it serves.
Washington University Medical Center in conjunction with St. Louis Children’s Hospital has a decades-long track record in 3D printing. Dr. Anwar tells us that it began with making patient-specific models for craniofacial disorders involving malformations of the face and skull. Examples of disorders include cleft palate and cleft lip with or without a cleft palate. The CDC recently estimates that, each year in the United States, about 2,650 babies are born with a cleft palate and 4,440 babies are born with a cleft lip with or without a cleft palate.1 Fixing these abnormalities is ever so critical in children to restore appearance and the ability to speak, as they are still developing socially and, therefore, the ability to communicate is essential. The models were used initially for pre-surgical planning to practice the repair procedure and determine the optimal intra-operative approach and surgical instruments to be used. Eventually, this led to the development of a bank or library of 3D models of craniofacial abnormalities for use in training medical residents and fellows and, ultimately, the entire medical team, improving communication and understanding of the anatomy and pathology of each disorder and its treatment.
More recently, the cardiovascular team embraced 3D printing patient-specific models as a solution for better surgical planning. Often times these babies have a congenital heart defect - a problem that occurred as the baby's heart was developing during pregnancy. Congenital heart defects are the most common birth defects and according to the American Heart Association, affecting eight of every 1000 babies born in the United States.2 Dr. Anwar tells us that as a referral center, St. Louis Children’s Hospital sees the most complex cases, and repair requires operating on babies with hearts the size of walnuts. The use of multiple colors and compliant materials with the J750 printer adds information and even allows for repairs to be simulated. Patient–specific, life-sized heart models soon became an integral part of the pediatric cardiologists’ armatarium to improve diagnostic precision and surgical outcomes. Being able to physically hold the model and visualize the anatomy facilitates communication with the multidisciplinary medical team and helps the practitioners anticipate what complications may occur before and after the surgery. In addition, surgeons use the models to educate the parents on their child’s condition so they can make a shared decision about whether to proceed with the surgery.
Patient’s heart that was made on a Stratasys J750 multicolor, multi-material 3D printer and used to help plan the child’s procedure.
The 3D printing experience of pediatric plastic surgeons and cardiologists treating congenital defects generated a great amount of enthusiasm in other specialties, and was soon followed by cases in vascular surgery, adult structural heart disease, interventional cardiology, and orthopedic surgery. With the opening of the new 3D Print Center, modeling for spine surgery, neurosurgery, general surgery, and anesthesia for difficult airway cases is anticipated.
Initially, the models were made through an external commercial 3D printing company. Over time, as volume built, a mix of internal and external printing occurred. Historically, internal printing was decentralized with each surgical specialty printing its own 3-D models. Eventually, clinical leaders of the hospital wanted to bring 3D printing inside and centralize the function. Fortunately, thanks to a generous donation from the Children’s Hospital Foundation and space and personnel commitment from the hospital, this became possible. “We are excited to be opening our center March 9, 2018 with its own dedicated physical space and a full time 3D engineer to communicate with physicians about the models’ objectives, to produce the models, and ultimately improve patient care,” Dr. Anwar says.
“With the consolidation to one 3D printing laboratory, Washington University, Saint Louis Children’s Hospital and BJC Healthcare is at the forefront of personalized medicine. Future plans include modeling of physiology and anatomy, for example, simulating blood flow in the model to allow us to accurately predict the response during the actual surgery. Our biggest challenge is to demonstrate that 3D patient-specific models improve clinical outcomes and bring value. Anecdotally, we know surgeons spend less time in the operating room when patient-specific models are used for surgical planning, and there is emerging literature quantifying these outcomes. We are currently part of a multi-center trial tracking intraoperative time, blood loss, time on bypass, ICU time, and complications.” As in aviation, and in virtually all other professions that are based on technical skills, simulation and practice of the planned procedure is key to a positive outcome. So, why would you not use 3D printing to facilitate better visualization and optimize the patient outcome?
Citations
1. Parker SE et al for the National Birth Defects Prevention Network. Updated national birth prevalence estimates for selected birth defects in the United States, 2004-2006. Birth Defects Research (Part A): Clinical and Molecular Teratology 2010; 88:1008-16.
2. Go AS, Mozaffarian D et al on behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics-2013 update: a report from the American Heart Association. Circulation. 2013; 127:e6-e245.
