3D printing for sizing left atrial appendage closure device: head-to-head comparison with computed tomography and transoesophageal echocardiography

Hell, Michaela M.; Achenbach, Stephan; Yoo, In Seong; Franke, Jöerg; Blachutzik, Florian; Roether, J; Graf, Verena; Raaz‐Schrauder, Dorette; Marwan, Mohamed; Schlundt, Christian

doi:10.4244/eij-d-17-00359

Cited by 55 publications

(41 citation statements)

References 22 publications

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“…Several other groups, 16,17 including ours, 11 extended the concept to more complex procedures. Wang et al 18 and Hell et al 19 demonstrated high accuracy (z100%) of printed models in predicting correct device size in two prospective cohorts (n = 75 in total). Our study confirms these findings in a larger cohort and, importantly, provides outcome analysis for recommending updates in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Device Sizing Guided by Echocardiography-Based Three-Dimensional Printing Is Associated with Superior Outcome after Percutaneous Left Atrial Appendage Occlusion

Fan

Yang

Cheung

et al. 2019

Journal of the American Society of Echocardiography

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Background: Left atrial appendage (LAA) occlusion is an alternative to anticoagulation for stroke prevention in patients with atrial fibrillation. Accurate device sizing is crucial for optimal outcome. Patient-specific LAA models can be created using three-dimensional (3D) printing from 3D transesophageal echocardiographic (TEE) images, allowing in vitro model testing for device selection. The aims of this study were to assess the association of model-based device selection with procedural safety and efficacy and to determine if preprocedural model testing leads to superior outcomes. Methods: In 72 patients who underwent imaging-guided LAA occlusion, 3D models of the LAA were created from 3D TEE data sets retrospectively (retrospective cohort). The optimal device determined by in vitro model testing was compared with the actual device used. Associations of model-match and model-mismatch device sizing with outcomes were analyzed. In another 32 patients, device selection was prospectively guided by 3D models in adjunct to imaging (prospective cohort). The impact of model-based sizing on outcomes was assessed by comparing the two cohorts. Results: Patients in the retrospective cohort with model-mismatch sizing had longer procedure times, more implantation failures, more devices used per procedure, more procedural complications, more peridevice leak, more device thrombus, and higher cumulative incidence rates of ischemic stroke and cardiovascular or unexplained death (P < .05 for all) over 3.0 6 2.3 years after LAA occlusion. Compared with the retrospective imaging-guided cohort, the prospective model-guided patients achieved higher implantation success and shorter procedural times (P < .05) without complications. Clinical device compression (r = 0.92) and protrusion (r = 0.95) agreed highly with model testing (P < .0001). Predictors for sizing mismatch were nonwindsock morphology (odds ratio, 4.7) and prominent LAA trabeculations (odds ratio, 7.1). Conclusions: In patients undergoing LAA occlusion, device size selection in agreement with 3D-printed modelbased sizing is associated with improved safety and efficacy. Preprocedural device sizing with 3D models in adjunct to imaging guidance may lead to superior outcomes.

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Section: Discussionmentioning

confidence: 99%

Device Sizing Guided by Echocardiography-Based Three-Dimensional Printing Is Associated with Superior Outcome after Percutaneous Left Atrial Appendage Occlusion

Fan

Yang

Cheung

et al. 2019

Journal of the American Society of Echocardiography

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“…Moreover, other small reports suggest that CT may provide a more accurate measurement of the LAA and that LAA size is frequently underestimated when assessed by TOE. [26][27][28]…”

Section: Preprocedural Laa Imagingmentioning

confidence: 99%

Comparison of intracardiac and transoesophageal echocardiography for guidance of percutaneous left atrial appendage occlusion: A meta‐analysis

et al. 2019

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Aims We performed a meta‐analysis to compare the safety and efficacy of intracardiac echocardiography (ICE) vs transoesophageal echocardiography (TOE) for the guidance of percutaneous left atrial appendage occlusion (LAAO). Methods and Results A comprehensive search of the literature was performed, from inception to December 2018 using MEDLINE, Cochrane Library, and Google Scholar electronic databases, and references from articles. Publications comparing ICE and TOE for the guidance of percutaneous LAAO were included in the analysis. The co‐primary endpoints were procedural success and procedure‐related complications. Secondary endpoints included procedural and fluoroscopy times and the volume of contrast media used. Five studies were included in the analysis, providing a total of 1122 patients. Procedural success was similar with both techniques (pooled odd ratio [OR] 1.46, 95% confidence interval [CI] 0.77–2.75, P = 0.24, I2 = 0%), with a trend for less procedure‐related complications in the ICE group (pooled OR 0.57, 95% CI 0.31–1.05, P = 0.07, I2 = 0%). Neither procedural (mean difference −1.64 minutes, 95% CI −16.42 to 13.14, P = 0.83, I2 = 96%) nor fluoroscopy times (mean difference + 1.29 minutes, 95% CI −1.38 to 3.97, P = 0.34, I2 = 76%) varied significantly between groups. There was a reduction in the volume of contrast media used in the ICE group (mean difference −9.71 mL, 95% CI −14.61 to −4.81, P > 0.01, I2 = 0%). Conclusion Intracardiac echocardiography is a safe and effective alternative to TOE for guidance of percutaneous LAAO.

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“…Therefore, the three methods (TEE, cardiac CTA, and LAA angiography) commonly used for the clinical evaluation of the morphology and size of the LAA have their respective advantages and disadvantages. 25 Before LAA occlusion, TEE can clearly judge whether there is thrombus in the LAA and measure the basal orifice size and depth of the LAA, thereby providing the basis for the operator to select the occluder model. Cardiac CTA can achieve more objective and accurate measurement of the morphology and lobulation of the LAA and the parameters of the LAA orifice providing more sufficient basis for judging whether LAA occlusion is feasible.…”

Section: Discussionmentioning

confidence: 99%

Application of transesophageal echocardiography, left atrial appendage angiography, cardiac computed tomography angiography, and three-dimensional reconstruction model in left atrial appendage occlusion

Huang

Kang

Yuan

et al. 2020

International Journal of Distributed Sensor Networks

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Objective: The objective was to evaluate the application of transesophageal echocardiography, left atrial appendage angiography, cardiac computed tomography angiography, and three-dimensional reconstruction model in the left atrial appendage occlusion. Methods: A total of 53 patients with persistent atrial fibrillation hospitalized from January 2015 to February 2019 were selected. Transesophageal echocardiography and cardiac computed tomography angiography were performed simultaneously before operation, and three-dimensional reconstruction of the left atrial appendage model was performed based on the cardiac computed tomography angiography findings. The morphology and size of the left atrial appendage were displayed by the left atrial appendage angiography during the operation. Results: Cardiac computed tomography angiography revealed filling defects in the left atrial appendage in four patients, whereas transesophageal echocardiography revealed thrombosis in two patients of the four patients. According to the cardiac computed tomography angiography results, the morphology of the left atrial appendage was classified into chicken wing–like, cauliflower-like, wind vane–like, and cactus-like. The diameters and depths of the left atrial appendage measured by cardiac computed tomography angiography and three-dimensional reconstruction model were found to be the greatest, and the orifice sizes and depths of the left atrial appendage measured by the left atrial appendage angiography were the smallest. Conclusion: Transesophageal echocardiography, left atrial appendage angiography, cardiac computed tomography angiography, and three-dimensional reconstruction model can evaluate the morphology and size of the left atrial appendage. The cardiac computed tomography angiography and three-dimensional reconstruction model could demonstrate the internal structure of the left atrial appendage more clearly.

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3D printing for sizing left atrial appendage closure device: head-to-head comparison with computed tomography and transoesophageal echocardiography

Abstract: Patient-specific CT-based 3D printing models may assist device selection and prediction of device compression in the context of interventional LAA closure.

Cited by 55 publications

References 22 publications

Device Sizing Guided by Echocardiography-Based Three-Dimensional Printing Is Associated with Superior Outcome after Percutaneous Left Atrial Appendage Occlusion

Device Sizing Guided by Echocardiography-Based Three-Dimensional Printing Is Associated with Superior Outcome after Percutaneous Left Atrial Appendage Occlusion

Comparison of intracardiac and transoesophageal echocardiography for guidance of percutaneous left atrial appendage occlusion: A meta‐analysis

Application of transesophageal echocardiography, left atrial appendage angiography, cardiac computed tomography angiography, and three-dimensional reconstruction model in left atrial appendage occlusion

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