Impact of three-dimensional heart models on surgical planning and outcomes in congenital heart disease: a systematic review and meta-analysis

Clinical Snapshot

Key Findings

• P Value: Not explicitly reported but CIs exclude null for most outcomes

• Effect Size: RR 1.42 for plan modification; MD -18.4 minutes for operative time

• Primary Outcome: Surgical plan modification more frequent with 3D models

• Nnt Or Sensitivity: Number needed to treat approximately 6 patients with 3D models to prevent one complication (calculated from RR 0.74)

• Confidence Interval: Plan modification: 95% CI 1.21 to 1.67; Operative time: 95% CI -27.6 to -9.2 minutes

Clinical Application

Requires access to 3D printing or virtual modelling technology, additional time for model preparation, and surgeon training Relevant to Australian paediatric cardiac centres; technology costs may require consideration for PBS funding; aligns with RACGP emphasis on patient-centred care and surgical safety Patients undergoing congenital heart surgery, particularly those with complex anatomical defects

Abstract

BACKGROUND: Congenital heart disease surgery includes intricate structures that are perhaps hard to completely understand by traditional two-dimensional shapes. Individualised, centre-based three-dimensional (3D) heart models may enhance structural imaging and surgical preparation, while data on their medical effect continue to be unpredictable and uneven. This systematic review and meta-analysis assessed the impact of 3D heart simulations on surgical preparation and outcomes in congenital cardiac disease. OBJECTIVE: To assess the successful outcomes of patient-centred 3D cardiac simulations in medical preparation, intraoperative execution and surgical results in patients experiencing operation for congenital cardiac disease. OBJECTIVE: To evaluate the impact of patient-specific 3D heart models on surgical planning precision and preoperative outcomes in congenital heart disease surgery. METHODS: A systematic review and meta-analysis were performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 standards and prospectively registered in PROSPERO (CRD42024211985). PubMed, Embase, Scopus and Cochrane CENTRAL were searched through March 2025 for comparative studies evaluating 3D-printed or virtual heart models versus conventional imaging. Outcomes were harmonised and pooled as risk ratios (RRs), mean differences (MDs) or standardised MDs (SMDs) with 95% CIs using random-effects models. RESULTS: 32 studies (n=1842) met inclusion criteria. The use of 3D models was associated with more frequent surgical plan modification (RR 1.42; 95% CI 1.21 to 1.67), reduced operative time (MD -18.4 min; 95% CI -27.6 to -9.2), lower postoperative complications (RR 0.74; 95% CI 0.56 to 0.98) and reduced re-operation (RR 0.52; 95% CI 0.31 to 0.86). Hospital stay was shortened (MD: 1.8 days; 95% CI -3.0 to -0.6), and surgeon confidence improved (SMD 0.88; 95% CI 0.60 to 1.15). The confidence of indication extended from modest to small because of non-experimental research and variability. CONCLUSION: Individualised-centred 3D heart stimulation improves structural imaging and medical preparation in congenital cardiac disease, chiefly for intricate lacerations and can increase preoperative competence, while statistics for conclusive diagnosis results continue to be restricted and mainly experiential. Upcoming potential, large-scale investigator-led research with consistent result events are required to ratify their medical success.

References

1. 1.Arero, G., Jarsso, G., Wako, A., Fekadu, D., Mardasa, K., & Godana, H. (2026). Impact of three-dimensional heart models on surgical planning and outcomes in congenital heart disease: a systematic review and meta-analysis. Open Heart, 13(1), e004011. https://doi.org/10.1136/openhrt-2026-004011