Short Overview on Trans-Septal Puncture Phantoms Materials and Manufacturing Technologies

The growing cooperation between physicians and engineers have been producing increasingly sophisticated anatomical phantoms for the training and planning of Structural Heart Surgery. Trans-Septal Puncture (TP) is a percutaneous, non-invasive cardio chirurgical procedure used to access the heart Left Atrium from the Right Atrium through the Fossa Ovalis (FO), a region of the Inter Atrial Septum with reduced thickness. TP is technically challenging and requires dedicated teaching and a skillful operator; as a result, application of phantoms to TP training have been gaining increasing interest. The aim of the present work is to investigate the current state of the art in TP simulators. The Scopus and PubMed databases were analyzed and the bibliography of the most impacting articles was reviewed. The results can be summarized as follows: i) mold casting and additive manufacturing (AM)are the only technologies documented for phantoms creation; ii) silicone rubbers and Polyvinyl Alcohol Cryogel are the most used materials for mold casting while Polyjet polymers are the most used material for AM; iii) quantitative data on force and haptic feedback from IAS and FO simulacra is scarcely documented; iv) procedure image guidance can be simulated during the training.