Applications of low-cost 3D printing in left atrial appendage closure using epicardial approaches – initial clinical experience

Abstract

IntroductionLeft atrial appendage occlusion procedure (LAAO) became an alternative method for stroke prevention in atrial fibrillation (AF) patients with contraindication or intolerance for oral anticoagulation therapy. However, LAA anatomy is complex with several different types of LAA morphology. Therefore matching the correct size of a delivery device to LAA morphology is difficult. In such circumstances, the 3D-printed model of LAA closure may be useful for preoperative planning which increases the efficacy of LAAO procedure.Material and methodsWe report as a first 2 cases of LAA occlusion procedure using 2 different systems: thoracoscopic AtriClip and the LARIAT device in which a 3D printed LAA model was used in preoperative planning.ResultsIn the first patient, preoperative measurements of 3D LAA model were performed using a dedicated selection guide for AtriClip device were comparable with the intraoperative examination. Left atrial appendage was closed epicardial using 40 mm size AtriClip. In second patients, LAA closure was performed completely percutaneously using LARIAT device. For better visualization of LAA shape on fluoroscopy and TEE examination, intraoperatively sterilized 3D LAA model was used during the procedure. In both cases, intraoperative TEE examination confirmed complete LAA closure with no leak.ConclusionsLeft atrial appendage 3D model is a useful tool in preoperative planning of a left atrial appendage occlusion using epicardial approaches with thoracoscopic or percutaneous access using LARIAT device. The quality of low-cost 3D printed LAA model is sufficient in planning minimally invasive procedure.

Long term outcomes after left atrial appendage closure with the LARIAT device—Stroke risk reduction over five years follow-up

“…However, there is a large group of patients in whom OAC therapy is contraindicated or ineffective [1,17] or in whom OAC present fatal complications observed that are observed also in new oral anticoagulants[18]. In recent years LAAC has become an increasingly popular alternative [19–21]. ESC guidelines now include LAAC as a Class 2 B recommendation for patients with AF with a contraindication to OAC or a clinical history of severe bleeding [1].…”

Reduction in risk of stroke and bleeding after left atrial appendage closure with LARIAT device in patients with increased risk of stroke and bleeding: Long term results

“…8 procedures are currently one of the fastest developing branches of interventional cardiology and indications for LAAO are extending. 1,4,9,10 Previous short-term studies showed that LAAO procedures are efficacious, safe and are widely performed in clinical practice. 11 However, few published studies evaluate the long-term efficacy of LAAO procedures in high risk patients based on CHA 2 DS 2 -VAS-score.…”

“…In recent years left atrial appendage occlusion (LAOO) has become an alternative treatment for stroke prevention in AF patients regardless of patients age . LAAO procedures are currently one of the fastest developing branches of interventional cardiology and indications for LAAO are extending . Previous short‐term studies showed that LAAO procedures are efficacious, safe and are widely performed in clinical practice .…”

A Comparative Study of Three Imaging Modalities for the Size Selection of Left Atrial Appendage Closure Device

“…The relationships between the measured values of each method and the size of occlude are also not clear. Previous results suggested that the LAA ostial size measured by CTA was larger than that of TEE and DSA [10,11]. Reports by Chow et al indicated that the narrowest limits of agreement were shown in the correlation of the device size and CTA measurements, the choice of the left atrial appendage occluder size based on the CTA measurements was more accurate than the conventional TEE [12].…”