Cardiac surgery: this is how, thanks to 3D printed hearts, young doctors from emerging countries learn how to operate

Cardiac surgery: this is how, thanks to 3D printed hearts, young doctors from emerging countries learn how to operate

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OfRuggiero Corcella

With the help of new technologies, the Æsculapius project of the Cardiopathy Children in the World association aims to train 120 young cardiac surgeons and cardiologists in two years who will thus be able to carry out operations in their countries of origin

What it feels like to operate on a heart 3D printed? The 54 young surgeons from 12 countries around the world who were trained thanks to the know something about it Æsculapius project of advanced cardiac surgery, cardiology and pediatric echocardiography training offered free of charge for humanitarian purposes byAssociation of Children with Heart Disease in the World. The goal is to prepare 120 young cardiac surgeons and cardiologists in two years coming from emerging and developing countries through the organization of innovative surgical technique courses.

In addition to training for cardiac surgeons, the Æsculapius Project also includes sessions dedicated to pediatric cardiologists to teach them the most advanced techniques of echocardiography pediatric and neonatal for the correct and early diagnosis of congenital heart diseases. In this case the practical training session makes use of a mannequin of a newborn baby which is used to perform ultra-realistic, accurate and high-fidelity ultrasound scans.

Over 6 million children suffer from heart disease in the world

There are more than 6 million children in the world heart patients. Although heart disease has a similar incidence everywhere, What makes the difference between life and death for many young heart patients is the place of birth. In rich countries – Europe and North America -, in fact, congenital heart defects are mostly diagnosed during pregnancy and treated surgically already in neonatal age: here 85% of operated children become adults.

In developing countries or war zones, where 2 million children with heart disease are born every year, at least 1 million and 500 thousand of them have no hope of life. This is mainly due to the lack of adequate healthcare. The shortage of qualified medical personnel it is one of the most serious and complex problems of this social emergency. The training of young doctors is therefore an absolute priority for the poorest countries.

The Æsculapius project

We talked about it with professor Alessandro Frigioladirector of the Pediatric and Adult Congenital Cardiac Surgery Area at the IRCCS Policlinico San Donato and president of Cardiopathic Children in the World.

Professor Frigiola, what does the Æsculapius project consist of?
«Æsculapius is the god of medicine and benefactor of the world. This project takes its name because it provides young children’s heart surgeons from countries in difficulty the possibility of perfecting their technical skills by carrying out surgical simulation interventions on 3D printing models of complex cardiac pathologies. The hearts are printed in various sizes, even as small as a newborn’s heart, with an innovative plastic material that faithfully reproduces cardiac tissue».

«Training occurs through the organization of very intense courses, concentrated in one week, in which doctors can carry out up to two operations a day. All this is offered free of charge for humanitarian purposes by Children with Heart Disease in the World, which also supports the costs of the doctors’ accommodation, course registration, teaching materials and pocket money. The project started in July 2023 and has already trained 54 young surgeons from 12 countries.”

In emerging countries there is a lack of facilities and doctors

In what conditions do you operate today in the countries where you operate?
«Cardiopathic Children in the World intervenes in countries such as Kurdistan, Syria, Romania, just to name a few, where unfortunately the structures dedicated to cardiac surgery in general and to pediatric surgery in particular are still very lacking. Sometimes we are faced with particularly difficult logistical situations because tools and equipment are missing suitable for the diagnosis, which is why we often have to bring them with us in our operating missions. The biggest difficulty, however, is the lack of specialized doctors».

What are the standard hospital equipment for this type of surgery?
«Pediatric cardiac surgery requires a different organization than that for adults or a traditional surgery center. Ci want high level dedicated staff, the equipment must be technologically advanced, because childhood pathologies are much more complex than those of adults, and proportionate to the weight of the patients. Machines for intensive care and operating rooms, for example, must be designed to work even with very small children, who weigh just one and a half or two kilos.”

From 6 to 18 years old to train a children’s heart surgeon

How are doctors trained?
«To become a children’s heart surgeon it takes a lot of time and training, which usually varies between 6 and 18 years. The opportunity to practice is crucial. They are usually used in training courses pig hearts, whose tissue is the most similar in nature to that of humans. These hearts, however, are significantly larger than those of a newborn, infant or adolescent and do not present pathologies. In emerging countries, there are very few pediatric cardiac surgeons and they almost never have the opportunity to carry out the training necessary to specialize adequately.”

«To shorten these times, we can make use of simulation training. It allows you to make great progress in a short time by practicing on 3D printed heart models as on real patients. Only by having more trained doctors and healthcare personnel will we be able to truly reduce errors and complications and be able to make a difference, saving many more children with congenital heart defects.”

The contribution of new technologies

How can innovative tools such as 3D printing, virtual and augmented reality (VR and AR) facilitate the training of healthcare personnel in economically disadvantaged countries?
«Thanks to these new technologies, the skills and performance of doctors can be significantly improved. On a 3D printed heartin particular, the cardiac surgeon can reproduce the same operation he would do on the living patient.”

«This allows him to accumulate valuable experience in a short time which he could not do in the operating room. For a doctor who works in areas of the world where there is no opportunity to train, being able to come to Italy to participate in training that uses these technologies means saving lives once he returns to his own country.”

The peculiarities of 3D printing

How are 3D hearts “made” and what advantages do they offer?
«3D hearts, printed with an innovative plastic material that reproduces cardiac tissue as faithfully as possible, allow cardiac surgeons to practice a potentially infinite number of times to improve their operating technique. They also have the advantage of being able to be produced in different sizesdepending on the age of the hypothetical patient, recreating the real pathologies that cardiac surgeons will have to treat during their professional lives.”

A moment of training

Remote comparison

Will the project allow distance learning?
«The Æsculapius project, being focused on practical simulation, does not include distance learning. However remote comparison for the discussion of patient cases is already an integral part of our support intervention for doctors in the countries in which we operate”.

How surgical techniques have evolved

In light of your long professional experience, how has medical-surgical training changed?
«Surgical techniques they are 90% the same as 20 years ago, what has changed is the experience. New technologies, as mentioned, can help improve and speed up the learning process of new doctors. New technologies also make the difference extracorporeal circulation and for intensive care with the aid of ECMO, ventricular assistance used when the heart needs temporary help to overcome surgery.”

Also simulate the act of sewing

Do you believe that new digital health tools can be valid substitutes for traditional practice?
«Digital health tools are certainly a valid help. We can consider them a valuable completion of a training and school project. Æsculapius proves it, managing to practically simulate even the delicate and essential act of sewing. Virtual realitythen, integrated with 3D printing, it can facilitate anatomical reproduction and understanding of the operation.”

March 30, 2024

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