Implementing Cost-Effective 3D Printing for Congenital Heart Surgery: Early Experience From a Single Center Using Open-Source Software and Affordable Technologies

Over the past decade, 3D printing has become a valuable adjunct for simulation and preoperative planning in congenital heart surgery (3). However, its broader adoption is often constrained by cost (3). The authors describe a pragmatic, low-cost pipeline that relies on open-source segmentation software and affordable consumer-grade printers while maintaining clinical utility. 

The program began in February 2024 with a team of eight, including two attending cardiac surgeons, one congenital fellow, and five medical students. The start-up hardware comprised two previously owned printers: the Prusa Mk3S+ and the Anycubic Photon Mono X, totaling €1450 (€900 and €550, respectively). To date, seven life-sized cardiac models have been produced (three plastic/stereolithography (SLA) and four silicone/Fused Deposition Modeling (FDM)) and applied across three adult congenital cases (Scimitar syndrome, atrial aneurysm, and persistent left superior vena cava). 

Computed tomography (CT) and magnetic resonance imaging (MRI) data sets from preoperative assessments were imported into itk-SNAP for manual thresholding and region-of-interest segmentation before being exported as STL files. The average segmentation time from image to STL was approximately one hour. Models were printed using FDM (silicone-like, flexible models) and SLA (rigid, high-detail models). FDM prints were prepared using PrusaSlicer and fabricated on the Prusa Mk3S+ with DevilDesign 1.75 mm PLA and Fiberlogy Fiberflex 30D. SLA prints were prepared in Lychee and fabricated on the Anycubic Photon Mono X with 405 nm photopolymer resin. Both modalities achieved a z-axis resolution of 0.01 mm. 

The models supported multidisciplinary preoperative planning and fellows’ training, receiving uniformly positive qualitative feedback from surgeons and cardiac imaging specialists. The per-model material costs and production times are summarized below and benchmark favorably against literature reports, which indicate costs of €80–€120 per model and approximately 15.6 hours from image to model completion (1, 2).

In summary, an open-source, low-budget 3D-printing program for congenital heart surgery is both feasible and sustainable, with per-model costs ranging from €5 to €15 and production times of approximately 19 to 20 hours. Next steps include scaling case selection, refining materials and workflows, and prospectively quantifying the effects on operative planning, efficiency, and cost-effectiveness. 

References

1. Arango, S., Gorbaty, B., Brigham, J., Iaizzo, P. A., & Perry, T. E. (2023). A role for ultra-high resolution three-dimensional printed human heart models. Echocardiography, 40(7), 703–710. https://doi.org/10.1111/echo.15637
2. Heying, R., Gómez-Ciriza, G., Gómez-Cía, T., Rivas-González, J. A., Nieves, M., Forte, V., & Valverde, I. (2021). Affordable Three-Dimensional Printed Heart Models. Frontiers in Cardiovascular Medicine, 1, 642011. https://doi.org/10.3389/fcvm.2021.642011
3. Yoo, S. J., Hussein, N., & Barron, D. J. (2022). Congenital Heart Surgery Skill Training Using Simulation Models: Not an Option but a Necessity. Journal of Korean Medical Science, 37(38). https://doi.org/10.3346/jkms.2022.37.e293

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