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Prospective Patch Planning Workflow For Branch Pulmonary Artery Reconstruction
Dominic Recco, MD, Shannen Kizilski, PhD, Jocelyn Davee, MS, Nicholas Kneier, MS, Patrick Earley, BS, Peter Hammer, PhD, David Hoganson, MD.
Boston Children's Hospital, Boston, MA, USA.
Objective(s):_Reintervention after branch pulmonary artery (bPA) patch augmentation is up to 60%. We developed a workflow to design patient-specific PA patches to achieve normal reconstructed anatomy.
In-vitro preclinical validation was conducted in a model of neonatal bPA stenosis.
Methods:_Utilizing segmented 3D model of patient-specific anatomy, virtual surgery is performed to enlarge stenosed bPAs. Target geometry is planned to z-score 0 diameter. Native PAs are virtually enlarged to target size, and remaining tissue required to achieve target size defines patch shape. Patch is flattened, offsets added to accommodate suture-line material uptake, and markings placed for intra-operative alignment. Template is laser-projected onto sterile material for use in OR. For
in-vitro validation, physiologically compliant silicone model was created with 5.8mm diameter and 2.9mm central stenosis under 30mmHg pressure and 30% prestretch. Segmented models were created from microCT, and workflow was followed to design patches to restore stenosed region to target diameter. Designs were evaluated across three patch materials with postoperative microCTs acquired to assess reconstruction accuracy.
Results:_Models reconstructed with silicone patches(n=3) achieved 5.6±0.1mm vs. 6.1±0.1mm with both bovine pericardium(n=6) and porcine bPA(n=3). Diameter error was largest with porcine bPA patches (5.3±1.8%) and all reconstructed tubes were within 0.5mm (9%) of target diameter.
Conclusions:_This study demonstrates precision of patch-planning workflow for reconstruction of neonatal-sized bPAs to mitigate reintervention. Further
in-vitro validation with patient-specific imaging will precede pilot clinical implementation.
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