Salute Sette, the breath given to the 5-year-old child with the first "bronco" 3d

In the Bambino Gesù pediatric hospital there is another step forward for international health: the first operation in Europe of implanting an organ printed with bio-resorbable material. The small patient, suffering from bronchomalacia, now breathes independently. 3D "bioprinting" opens the new era of pediatric airway surgery. It is great news for the whole of Italy and for children suffering from severe respiratory problems.

Today it is possible to save the breath of a five-year-old with 3D resorbable "broncho" printed. At the Bambino Gesù Pediatric Hospital, a unique operation at European level was successful, which opens the way to salvation for many children who suffer: an experimental intervention on a patient suffering from bronchomalacia, a collapse of the bronchial wall that prevented the normal flow of air in the left lung. A similar operation had not yet been seen in Europe. It took 6 months to bring the device to life: a long and arduous team effort to get a child back to breathing properly. "The 3D 'bronco' was entirely designed for Bambino Gesù with sophisticated imaging and bioengineering techniques – the experts explain – It was printed with bio-resorbable material that will be progressively eliminated from the body after accompanying the growth of the respiratory system child and returned to the bronco its functionality. A little less than a month after the operation, the child was able to return home ”.

HOW THE 3D DEVICE IS BORN

The 3D "bronco" is born of a project of the Child Jesusbased on a study by the University of Michigan, in the United States, where the first 15 such installations were performed. The personalized device was designed on the anatomy of the small patient starting from the two-dimensional images (TAC) realized in the Department of Diagnostic Imagingby dr. Aurelio Secinaro and then reworked with sophisticated bioengineering techniques by dr. Luca Borro of theInnovation Units and Clinical Pathways. The three-dimensional model, a cylindrical “cage” that reproduces the structure of the bronchus, was printed with polycaprolactone and hydroxyapatite, a bio-resorbable compound that is eliminated by the organism over a period of about 2 years.

There 3D printing was entrusted, as part of a research project, to the center of 3D printing Prosilaswho found and adapted the material to their own technologies. Before the implant, the "bronco" was subjected to sterilization processes at low temperature in order not to alter its structure and characteristics. For the mechanical strength testthe hospital made use of the collaboration of theUniversity of Modena and Reggio Emilia. With compassionate use authorizationof the experimental device granted by Ministry of Health, the surgeon team was able to proceed with the operation. The entire process, from design to intervention, required over 6 months of intense teamwork.

THE SURGERY

It took as much as eight hours for the 5-year patient to implant: the operation was performed on October 14, 2019 by dr. Adriano Carotti, head of theComplex Heart Surgery Function Units with Innovative Techniques, in collaboration with the airway surgeons of the Laryngo-Tracheal Team, directed by dr. Sergio Bottero.

The child's bronchus was crushed between the left pulmonary artery and the descending thoracic aorta. This long-standing compression generated the narrowing of the respiratory tract and the collapse of the cartilage rings that support the bronchus wall. Because of breathing difficulties, at night the child needed the support of the machinery for non-invasive ventilation.

During the operation, performed in extracorporeal circulation, cardiac surgeons moved the pulmonary arteries that caused bronchial crushing, so they performed the implant. The device was placed outside the diseased bronchus anchoring the weakened tissue to the 3D cage with sutures. Airway surgeons performed pre, intra and post operative monitoring. A little less than a month after the operation, the child returned home with his family. Now he is able to breathe normally.

BRONCOMALACIA: NEW POSSIBILITIES OF CARE WITH 3D BIOPRINTING

The loss of the support function by the cartilage rings that make up the airways is called malacia of the bronchi: it is a relatively rare lesion that produces a limitation of the normal gas flow through the airway and can lead to respiratory failure. The weakened cartilage, in fact, tends to collapse mainly during the expiratory phase, of which it prolongs its duration. Moreover, it tends to prevent expectoration, causing the entrapment of secretions and favoring lung infections. The bronchomalacia is linked to different causes: it can have a genetic origin; can associate with certain forms of prematurity; it can manifest itself after traumas and chronic inflammations or be caused by the compression exerted by abnormal blood vessels. Most cases of vascular compression resolve with the removal of the cause (for example, repositioning the responsible blood vessels). In more complex situations, when the long-lasting compression produces "collapse" of the bronchial wall, eliminating the cause of bronchomalacia is not sufficient and it is also necessary to resort to the implantation of a support structure.

"The 3D devices made with resorbable material, destined to disappear and to perform their function in a little traumatic way, represent the new frontier of pediatric area surgery in the streets»Explains the cardiac surgeon Adriano Carotti. "Soon they will be able to completely replace silicone stents, easily dislocated, and metal stents which, once incorporated in the airway wall, are no longer removable and can interfere with the growth of the child's respiratory system. The 3D "bronco" implanted on our little patient, on the other hand, will disappear from the body within a couple of years. It is reasonable to think that, in the meantime, it will have induced the generation of a peribronchial fibrous reaction that somehow "replaces" the ruined cartilage function: the bronchus will thus be able to sustain itself on its own and will have the possibility of developing and continuing to to grow up»

Gaetano Gorgoni

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