Objet260 connex3 printer

The rigid phantom model mimicking a straight aortic neck was designed with Solid Works SP3 software (Dassault Systèmes SolidWorks Corp., Vélizy, France). The branches were constructed of modular detachable components and manufactured of a transparent PolyJet photopolymer (VeroClear; Stratasys, Eden Prairie, Minnesota) by 3-dimensional printing with the Objet260 Connex3 printer (Stratasys) at the University of Twente (Enschede, The Netherlands) with an accuracy of ≤3 µm. The anatomical characteristics of the in vitro model, such as diameters and aortic branch angles, were based on average human anatomy.^{5 (link),6 (link)} The phantom model had an inner aortic diameter of 26 mm and branch diameters of 6 mm. The aortic branch angles were 45°, 60°, and 90° (Figure 1).

The process of 3D printing included image segmentation and exporting in standard tessellation language (ie, STL) file format using 3D Slicer, correction of the standard tessellation language model by MeshMixer (Autodesk, Inc) and 3D printing with a Stratasys Objet260 Connex 3 printer (version 29.11.0.19189). The resins used were VeroWhite Plus, VeroBlack, and VeroMagenta for the valves and TangoPlus for the cardiac chambers and vessels. A 1:1 scale 3DPHM (Figure E3) was presented in 3 parasagittal slices allowing complete visualization of cardiac chambers and great vessels. A third and final decision was then recorded.
At the end of the simulation, the previous original heart team decision as well as operative records with perioperative findings and performed surgical procedure were revealed. On the basis of the latter, an institutional retrospective surgical strategy, defined as a composite of the performed procedure and the final simulated heart team decision considering currently available expertise, was finally defined as the gold standard and compared with each of the 3-step decisions.