Doctors use 3D bioprinter to create a splint for baby’s blocked throat

The Youngstown, Ohio, baby turned blue again and again as his little airways collapsed and kept air from reaching his lungs. But doctors used a 3-D bioprinter to custom-make a splint that is holding his airway open and helping him breathe.

Now 19-month-old Kaiba Gionfriddo is “into everything”, says his mother, April Gionfriddo.

“Quite a few doctors said he had a good chance of not leaving the hospital alive,” she adds.

Kaiba was born with a rare condition called tracheobronchomalacia. This deformity affects about one in 2,200 babies and causes the airways to be weak and prone to collapse. In tiny babies, it can look like asthma and it can take a while to diagnose.

Doctors at the University of Michigan bioprinted this splint, custom designed for Kaiba Giofriddo’s trachea. It fits around the outside and supports the windpipe.

Green and Hollister were able to make the custom-designed, custom-fabricated device using high-resolution imaging and computer-aided design. The device was created directly from a CT scan of Kaiba’s trachea/bronchus, integrating an image-based computer model with laser-based 3D printing to produce the splint. The image-based design and 3D biomaterial printing process can be adapted to build and reconstruct a number of tissue structures. Green and Hollister have already utilized the process to build and test patient specific ear and nose structures in pre-clinical models. In addition, the method has been used by Hollister with collaborators to rebuild bone structures (spine, craniofacial and long bone) in pre-clinical models.

Kaiba needed a ventilator to breathe, and wasn’t going to be able to survive without it. Worse, he struggled and had to be sedated to tolerate the breathing tube.

“Some of the arteries, especially those coming off the aorta, are malformed,” said Scott Hollister, a professor of biomedical engineering at Michigan. “They almost form a ring around the trachea. If it’s too tight, they actually compress the airway, which happened in Kaiba’s case.”

Again and again, Kaiba’s floppy airways collapsed.

Replacing the entire trachea is complex. “We felt the simplest solution was to build a device that would go around the trachea,” says Hollister.

They developed a program that would design the horseshoe-shaped device, complete with small holes to allow a surgeon to suture it into place. “Then we made a model of his trachea,” says Hollister. “Just to be sure, we made it in a range of sizes.”

Hollister’s team used a bioplastic powder called polycaprolactone. “It’s a polymer that is approved by the Food and Drug Administration to fill small holes in the skull,” Hollister says. The bioprinting machine melts the powder, and builds the desired shape layer by layer.

The University of Michigan team got special permission from the school’s advisory board and the FDA to go ahead. “I was a little scared at first because the doctor said he wasn’t sure it was going to work at first,” Gionfriddo says.

In February of 2012, a surgical team re-arranged Kaiba’s twisted heart arteries and trachea, and then carefully placed the splint.

“It was amazing. As soon as the splint was put in, the lungs started going up and down for the first time and we knew he was going to be OK,” says Green. In three years, they expect the material will be completely reabsorbed and excreted by the body. By then, his own airways will be able to function on their own, doctors say.

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