The application of 3D printing technology in minimally invasive coronary artery bypass

Background: Minimally invasive cardiac surgery has gained importance for preserving sternum stability, reducing pulmonary complications, and enabling faster recovery. MICAB, a newer technique, involves bypassing coronary arteries with minimally invasive methods. Key challenges include determining the appropriate length of saphenous vein grafts (SVG), as errors in graft length can compromise the procedure. Objective: The aim of the study was to develop a 3D model of the patient's heart and coronary system using 3D printing technology to help with preoperative visualization, graft placement, and the determination of the optimal graft length for MICAB surgery. Methods: 20 patients with multivessel coronary artery disease were selected. Preoperatively, coronary CT scans were performed, followed by 3D reconstruction and modeling. Subsequently, patient-specific models were printed using stereolithography (SLA) technology. Under general anesthesia, a minimally invasive approach via left anterior mini-thoracotomy was used to perform MIDCAB. 30 days after surgery, coronary CT scans were performed to assess graft patency and morphology. Estimated length of vein graft was measured based on 3D heart model, while actual length of vein graft was obtained though postoperative CT scan. Results: The study demonstrated the feasibility and accuracy of using 3D-printed models for preoperative vein graft length estimation in MICAB. The mean difference between estimated and actual graft lengths was small, with excellent correlation between preoperative simulations and intraoperative findings. postoperative outcomes showed 100% graft patency with no in-hospital mortality. Conclusion: The study concludes that 3D printing technology is a reliable tool for preoperative planning in MICAB. It enhances surgical precision, reduces intraoperative adjustments, and improves patient outcomes, though further studies are needed to explore long-term effects and optimize workflow.