3D printed training simulator for transcatheter edge-to-edge repair of the tricuspid valve: A proof-of-concept

Background: Tricuspid regurgitation (TR) treatments have gradually shifted toward a more interventional approach and transcatheter edge-to-edge repair (TEER) has assumed a first-order role. TriClip™ by Abbott (Menlo Park, USA) is one of the most widely used devices for tricuspid repair. TEER procedures are recognised as technically challenging, characterized by a steep learning curve. For this reason, specialized training is necessary. The aim of this work is to develop and test a novel 3D printed training simulator, which considers both anatomical and mechanical characteristics, specifically designed for this kind of procedure. Methods: Starting from routinely acquired computed tomography (CT) images, a 3D digital model of the heart was reconstructed. This was then properly “augmented”, so that it could realistically reproduce the key features involved in the procedure. The simulator was manufactured exploiting the Polyjet 3D printed. Proper materials selection was performed to accurately reproduce mechanical properties. The manufactured prototype was then tested by a specialized professional, with the TriClip™ system. Results: The simulator was assessed to practice access, navigation, catheter steering and leaflet grasping. Throughout the process, appropriately placed cameras ensured that the operators could visualize the crucial steps on a screen. Even if a deeper evaluation is needed, preliminary feedback is satisfactory. Conclusions: In this study, a new training simulator for TriClip™ procedure was designed, produced, and preliminary assessed. Further studies will have to demonstrate the advantages of using this simulator design to shorten the learning curve and subsequently lead to better clinical outcomes.