In the summer of 2022, a patient came into Henry Ford Hospital with an enormous hole in his heart. The hole was, more technically speaking, an atrial septal defect, a hole in the wall of tissue between the two upper chambers of the heart. An ASD can cause the two chambers to mix the incoming and outgoing blood supply, sending less-oxygenated blood for another round through the body.
If untreated, ASDs can lead to a host of serious issues, including heart failure. A small ASD is about 5 millimeters or smaller. Ten millimeters — about half the size of a dime — is considered large.
This patient’s was 40 millimeters, slightly bigger than a half-dollar coin. It was the largest they had ever seen.
Like many patients, he wasn’t eligible for open- heart surgery.
“The unfortunate reality is not everybody is going to be deemed a candidate for open-heart surgery because they’re just not strong enough,” says Dr. Dee Dee Wang, director of structural heart imaging at Henry Ford. “They will get admitted with heart failure to the hospital over and over again and their quality of life would deteriorate, and ultimately they will go down the route of hospice and death.”
The reason so many procedures require open-heart surgery is because surgeons, usually relying only on two-dimensional images prior to surgery, don’t always know exactly what they’re getting into until they open a patient’s chest and get a good look at the actual heart.
There are other ways to access the heart, such as a transcatheter procedure, in which doctors access the heart through an artery, entering near the groin, but for certain operations, such technology can be tricky because the doctors’ view is limited to a two-dimensional image that doesn’t allow for a lot of detail.
But the doctors performing this ASD repair knew exactly what to do through the transcatheter. They had seen the patient’s heart before — they had, in fact, held it in their hands. They were able to see and touch the heart for as long as they wanted, able to plan the procedure down to the smallest detail, to explore the exact size and shape of the hole they needed to repair.
That’s because Henry Ford Innovations, a department within Henry Ford Health, had made the doctors a three-dimensional rendering — a 3D print — of the patient’s heart.
Using technology that combines the 2D scans, technicians can make an exact replica of a heart — or other organs, or parts of organs — for surgeons prior to procedures. The renderings are so accurate — within 1 millimeter — they allow doctors to look closely at what is essentially the very organ they’re operating on, with all its specific issues and idiosyncrasies, and it was that which allowed doctors to enter this ASD patient’s heart and save it.
3D printing in the medical field isn’t exactly a rarity. Doctors can print copies, or even prosthetics, for all kinds of body parts. Even bioprinting — making organ prints that incorporate living cells or tissue — is also a growing field.
But what makes what’s happening at Henry Ford unique, Wang says, is that they’re able to do it so consistently, due to the fact that the hospital has one of the few in-house printing facilities in the country. Most other hospitals have to contract with outside companies.
And while the technology is there, it still hasn’t been widely adopted, mainly because insurance doesn’t cover 3D printing as part of procedures.
“It’s such a new technology. Even though we’ve been doing everything over nine years, very few hospitals have the capability to perform in-house 3D printing, or in-house computer-aided-design virtual twin 3D printing,” Wang says.
“We invested in this; we’re not going to wait for insurance. We’re doing this because our patients deserve this. … We made this technology available. We’re going to be operating in the 21st century for our patients.”
Sitting in her office at Henry Ford Hospital, Wang is flanked by shelves of transparent 3D-printed hearts of former patients that, from a distance, resemble something like jellyfish that have lost their tentacles.
About 10 years ago, Wang remembers, the hospital had a 3D printer, but “we didn’t have an understanding of what our need was.”
That was until the hospital recruited Dr. William O’Neill to head up the Center for Structural Heart Disease. O’Neill is considered a pioneer in the world of interventional cardiology and structural heart disease, being at the forefront of many major interventional cardiology advancements, including pioneering the use of angioplasty for the treatment of heart attacks and developing catheter-based treatments for structural heart disease. It was O’Neill, Wang says, who developed the vision of 3D printing at Henry Ford.
As we grew this program, he found significant clinical benefit; it helped him teach trainees more, helped the team see structures more clearly, and improved procedural times, procedural safety and patient outcomes,” Wang says.
Wang says there was a “huge unmet need” with patients who not only had other kinds of valve complications but were also too old to safely undergo open-heart surgery. 3D printing, she says, paved the way to make transcatheter replacements possible.
But it’s made other structural heart procedures possible, or more successful, too, she says.
One beneficiary was Gerald Gora. Earlier this year, he found that his aortic valve was leaking and needed to be replaced. At 81, he’s already undergone open-heart surgery five years before at a different hospital — with a rough recovery. Months after they’d sewn his chest back together, the wound became so infected he had to go back into the hospital.
“It just about killed me,” he says.
When he found out he needed another operation, he says he refused to go back under the knife. In February, he read an article in the Detroit Free Press about O’Neill and found a new cardiologist to refer him.
Two weeks to the day after the leaks were fixed and the valves replaced — two total operations in as many weeks — he says he’s feeling fine.
“We’re so lucky to be living in this day and age,” his wife, Barbara, says.
The innovation institute first started 3D printing hearts in 2013, and since then the hospital has printed more than 1,000, according to Wang. Between 2013 and 2016, Wang says they were able to improve patient safety on procedures like left atrial appendage closures (they help to prevent strokes) to achieve a 99 percent success rate while the national average was about 85 percent. The team also reduced procedure times using the 3D heart models, which, in turn, reduced recovery time.
While the institute started with printing 3D hearts, Henry Ford Innovations has branched out to help other departments as well (printing hearts, actually, has been handed over from the innovation institute to Wang’s department). Alexandra Moceri is the product designer for the innovation center. She’s responsible for bringing 3D prints to life — to give doctors what they need to do their jobs. Some prints might need to be scaled larger; some might need to be colored, or partially colored. During a recent Zoom call, she sat at a desk with a 3D-printed kidney in front of her. The kidney was transparent but with a red blob attached to it that looked like a giant wad of gum.
It was a tumor.
The doctors of the patient weren’t sure if they needed to remove the entire kidney or only part of it, and that’s where Moceri’s print came in.
“Based on this print, being able to see it in real time and coloring the print, showing the tumor, … they were able to make a decision before they got into surgery that they needed to take the whole kidney out,” she says. “[The doctors] were just thrilled because they were able to see much more with this print than they were able to with just the scan itself. So it really, really helped them pre-plan, and it cut down on time.”
There’s another benefit to the 3D prints at Henry Ford: patients’ peace of mind. It isn’t just the doctors who get to hold and touch the prints but also the patients. Sometimes doctors will show the patient a heart prior to surgery to help them understand the procedure. Other times patients see the hearts after surgery. Some take them home.
“When we have an 83-year-old or a 70-year-old coming in for a procedure, they have an easier time explaining to their family because they can say, ‘Oh, they’re going to go in this area of my heart and put this device in here. And we’re going to close this portion right here, and they’re going to do it this way.’ Whereas before that, physicians may talk and it might be too high-level for a patient to understand.”
In about a month, during his next follow-up appointment, doctors will show Gora the 3D printout of his heart they used to conduct his surgery.
What that looks like exactly “will be a surprise,” Gora says.