Not all children are the same: how the Aesculapius project uses imaging to bridge the gap in Congenital Heart Diseases.

Congenital heart disease (CHD), the most common congenital malformation worldwide, affects approximately 8-10 per 1000 live births. Despite major advances in diagnosis and treatment, significant disparities remain between high- and low-resource settings, with a substantial impact on survival and long-term outcomes. The Aesculapius Project was conceived to address these inequalities by employing advanced imaging and three-dimensional (3D) printing as educational tools to enhance paediatric cardiac surgery training. Initiated by the humanitarian foundations Bambini Cardiopatici nel Mondo and European Heart for Children, the program offers free training to early-career surgeons from resource-limited countries. Patient-specific 3D cardiac models are generated from computed tomography (CT) and magnetic resonance imaging (MRI) data and used in structured courses that combine lectures, supervised hands-on surgical simulations, and remote mentorship. To date, 81 physicians from 16 countries have participated in the program, performing 10-20 simulated procedures on complex CHD models under expert supervision. Technical performance scores improved by an average of 30%, and participants emphasized the educational value of repeated supervised practice and video-assisted review. The Aesculapius Project demonstrates that 3D anatomical models offer an ethical and effective platform for surgical education, representing a concrete step toward expanding access to high-quality paediatric cardiac surgery training in resource-limited settings.