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José Julio was born again on April 3. He was admitted to the Emergency Department of the Gregorio Marañón Hospital in Madrid with an aortic injury that had him on the verge of death . Saving his life went through a single option: follow the steps of a similar case at the Seattle Hospital in the United States. "We manufactured a 3D prosthesis of the damaged aorta area in the hospital itself in less than 10 hours and we introduced it in record time, before fatal bleeding occurred , which was what we feared would happen at any time" , says Javier Río Gómez, specialist in Angiology and Vascular Surgery of this health center. It was the first time it was done in Spain and it was a success that is pending international publication.

It was a decision against the clock. According to Río Gómez, "we had to explain to the patient the difficult situation. The injured area of ​​the aorta was very delicate and had to intervene by inserting a prosthesis as soon as possible, but if the pharmaceutical industry was in charge, it would not be available until about 30 days then we didn't have that much time. We ran the risk that it would become unstable with uncontrollable bleeding that would result in the patient's death. " In addition, it was a risky area because at that anatomical point "blood vessels originate that give flow to the kidneys and small intestine and conventional prostheses cannot be used."

José Julio together with the specialist Río Gómez.H. Gregorio Marañón

With these obstacles ahead and knowing the good results of several similar cases in the United States and one in Poland, the team of doctors of the Madrid hospital that attended to José Julio was launched for the first time in Spain to design the prosthesis using 3D printing , taking advantage of its recognized laboratory with this type of technology that has been applied in medicine since 2013.

When manufacturing everything 'at home', inside the hospital, "response times are shortened , which allows patients treated by emergencies or who have priority due to the degree of complexity to be treated more quickly," says Rubén Pérez Mañanes, president of the Commission of 3D printing of Gregorio Marañón.

In less than 10 hours the prosthesis was ready. From the data provided by the patient's scanner, a custom mold was made with the exact diameters and distances, tailored to the patient. Here, work and interaction between clinicians and engineers is crucial. With the information from the radiological study , Pérez Mañanes says, "the model is loaded with the printer and printed. Then, the sterilization time and the hospital circuit come into play so that this piece is available in the operating room if it were necessary to have it sterile or available at the test bench so that the surgeon can work with the replica ".

The result of this teamwork was the design of a prosthesis that coincided "exactly" with the aorta of José Juli or, repairing the injured area and at the same time respecting those holes necessary to maintain the flow of blood vessels essential for life.

3D printing laboratory of the Gregorio Marañón Hospital.SERGIO ENRÍQUEZ-NISTAL.

Until now, "what was done was to carve a conventional prosthesis. Doing it with this mold, totally precise in the angles and distances, has inherent advantages," underlines the vascular surgeon. The patient had a "really good postoperative period, without complications, being discharged almost at 48 hours."

" I went from being in a very critical situation in which with any movement the aorta could break and die leaving the hospital with a fantastic postoperative period without pain, " explains the patient. "It was the first time something like this was done in Spain and with that, they gave me life."

Having a laboratory with 3D technology inside the hospital makes it possible to shorten the manufacturing and distribution times of prostheses and this experience opens a window of opportunities to treat other cases. For this, it is necessary to have adequate infrastructure, knowledge and training.

The laboratory of Gregorio Marañón, a pioneer in the medical application of 3D printing , began operating in 2013 with an office printer. Gradually, it was equipped with more machinery with which, from three-dimensional maps of the human body made by radiological studies, tangible pieces are created on a real scale. As the specialists explain, having on hand printed models of fractures or tumors that are to be operated increases the ability to prepare the intervention more accurately. Increases effectiveness and reduces operating time and possible risks for the patient. In addition, these pieces also help explain to the patient their pathology or the procedure to be followed.

What began with a grant from the Orthopedic Surgery and Traumatology service, was expanding to other specialties such as cancer surgery, childhood cardiac surgery, neonatology or gynecology. These years of experience allowed the team of doctors who treated José Julián to be already trained in the management of the prostheses, but this, says Río Gómez, " was the first patient in which we introduced one of them ", which extends the range of possibilities of having such a laboratory in the hospital.

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