3Dプリンタモデルを使用した自己弁温存大動脈基部置換術のシミュレーション

A Simulation Surgery of Valve-sparing Aortic Root Replacement Using a Three-dimensional Printed Model

マルチスライスCTの進化に伴い，術前に手術野の立体的イメージを把握することが可能となったが，実際に手にとることは困難である．われわれは立体的構造が複雑な大動脈基部病変に対する自己弁温存大動脈基部置換術に際し，3Dプリンタモデルを作成し，術前シミュレーション手術を行ったので報告する．

Aortic valve-sparing surgery is a delicate procedure that requires specialized skills to control aortic valve regurgitation. Therefore, simulating the surgery before performing it on a patient is good practice for inexperienced surgeons. Herein, we present our experience of a simulation surgery using a three-dimensionally printed aortic root model of a 60-year-old man with severe aortic regurgitation and aortic root enlargement. We fabricated the model using multi-slice computed tomography data. The model revealed the two pitfalls：unbalanced commissure position and lower coaptation height of the right coronary cusp. We completed the simulation surgery from the proximal suture and valve reimplantation to coronary ostial reconstructions during approximately three hours with medical staffs. In the actual operation, the aortic valve regurgitation completely disappeared by accurately reconstructing the commissure in the Valsalva graft and adjusting the height of the right coronary cusp using central plication procedure. We believe that carrying out simulations before the actual surgery improves the surgeon’s confidence and the patient’s outcomes.