Innovation

Jason Ayres, a family doctor in Alabama, was speechless as he held his adopted son Patrick’s heart in his hands. Well, a replica of his son’s heart — an exact replica, 3-D printed before the 3-year-old boy had lifesaving open-heart surgery.

Patrick was one of the first beneficiaries of 3-D printing technology at Boston Children’s Hospital, which last year helped open a new frontier in pediatric cardiac surgery. Patrick was born with numerous cardiac problems; in addition to double outlet right ventricle and a complete atrioventricular canal defect, his heart lay backwards in his chest.

“We knew early on that he’d need complex surgery to survive,” says Jason.

Finely detailed models of Patrick’s heart created by the Simulator Program at Boston Children’s gave surgeon Sitaram Emani, MD, at the Boston Children’s Heart Center an up-close-and-personal look at his complex cardiac anatomy.

Emani, who directs the Complex Biventricular Repair Program at the Heart Center, says that it can take anywhere between 30 minutes and an hour in the operating room to sort out a patient’s cardiac anatomy. That’s all extra time the child is on cardiopulmonary bypass and anesthesia — precious time that the 3-D models can save.

“Not only can we eliminate this planning time in the operating room,” says Emani, “but we believe surgical techniques and outcomes will also improve due to that pre-planning.”

A heartfelt donation and a trial

Emani and his colleagues in the Department of Cardiac Surgery hope to prove this in a formal clinical trial. The trial will begin with a pilot study of 20 patients diagnosed with double-outlet right ventricle (DORV), a complex condition in which both the pulmonary artery and the aorta, the heart’s two great arteries, arise from the right ventricle. This causes oxygen-poor blood entering the heart to mix with oxygen-rich blood heading out of the heart, and as a result, the blood sent to the body lacks adequate oxygen.

The intricately complex, highly variable cardiac anatomy of DORV patients makes this condition ideal for modeling with 3-D printing.

A donation from the Boston chapter of the National Philoptochos Society, via the nonprofit organization Matthew’s Hearts of Hope, was key in launching the trial. Matthew’s Hearts was founded by Marie Hatcher in honor of her son Matthew, 7, who has complex congenital heart disease and received a second opinion from Boston Children’s in 2014. Matthew has had four open-heart surgeries for his complicated cardiac issues, including DORV, hypoplastic right heart syndrome, total anomalous pulmonary venous return and dextrocardia.

Matthew didn’t have his anatomy 3-D printed, but Marie heard of the work at Boston Children’s. “We felt really strongly that 3-D hearts are game-changing and we could make a big impact with a small amount of money,” says Hatcher. The ultimate goal is for insurance companies to pay for the 3-D printing, she says, “but the only way to do that is with proof from a study. It’s about results.”

Patrick’s story

Patrick is one of eight Ayres children: four biological and four adopted. His parents knew he had congenital heart disease before they brought him home from China.

When you fill out adoption paperwork, you can indicate which medical conditions you will consent to manage,” Jason explains, “The first time I adopted, I didn’t check off congenital heart disease, because I thought the likelihood someone with CHD could have a normal life was essentially zero. But now I know that’s not true.

After seeking care locally, it became clear to the family that Patrick needed extremely complex care, and they decided to make the trip to Boston. Jason had heard from friends about cardiologist Gerald Marx, MD, and called him directly. Soon, the Ayres were in Boston meeting with Marx and discussing the plan for Patrick’s surgery with Emani.

When [Emani] asked if we wanted to have a 3-D printed model of Patrick’s heart, it was kind of a no-brainer,” says Jason, a self-described geek. “It couldn’t hurt, and it would be kind of cool to have.”  Patrick was in the operating room for a total of 13 hours, 7 of which were spent on bypass. The 3-D printed heart allowed his surgeons to make the most of that time and operate with confidence. “Technology has assisted to give these kids a much greater expectancy as well as quality of life,” Jason says. “My wife and I firmly believe in supporting every effort to make procedures easier and take less time for these kids.”

After his successful surgery, Patrick now runs around playing with his seven brothers and sisters like nothing ever happened. And as for the 3-D heart, “They let us keep it!” says Jason. “I have it in my office now, and when people ask how Patrick did, I show them the heart.”

That highlights an additional benefit to the printed hearts: better patient education. “We can model every possible type of heart disease to show a family exactly what their child has,” says Emani. “It’s taking something complex and making it simple.”  Most importantly, when these children grow older and start asking questions about their heart conditions, they can hold the answers in their hands— and marvel at how far they’ve come.

-Erin Horan