An Innovative Hybrid Process for Realistic Three-Dimensional Heart Modeling and Surgical Simulation of Tetralogy of Fallot.

Background: Realistic three-dimensional (3D) heart models are essential for understanding complex congenital defects and improving surgical training. However, conventional rigid models lack the tactile and anatomical fidelity required for procedures such as Tetralogy of Fallot (TOF) repair. Objectives: To develop a reproducible, flexible, and anatomically accurate TOF heart model using a computer aided design (CAD)-driven hybrid workflow, validated against magnetic resonance imaging (MRI) data and assessed through hands-on surgical training. Methods: Anonymized MRI datasets were segmented and refined using a three-dimensional (3D) slicer. The resulting stereolithography (STL) files were imported into Autodesk Inventor to design molds, which were produced via 3D printing and silicone casting. Cardiologists and surgeons assessed anatomical fidelity during segmentation and mold design. Models were tested during an international surgical workshop, where participants practiced key TOF procedures. A structured survey evaluated anatomical accuracy, tactile realism, and educational value. Results: Among 125 participants from 60 countries, 100% reported that the model improved their understanding of cardiac anatomy; 91% (113/125) emphasized its educational usefulness; 82% (103/125) to 88% (110/125) confirmed anatomical fidelity; and 75% (94/125) rated tactile realism as comparable with real cardiac tissue. Conclusions: This CAD-silicone workflow produces reproducible, flexible, and anatomically faithful TOF heart models, effectively bridging imaging data and hands-on surgical simulation to enhance both surgical education and preoperative planning.