Improving Left Atrial Appendage Occlusion Device Size Determination by Three-Dimensional Printing-Based Preprocedural Simulation

Abstract

BackgroundThe two-dimensional (2D)-based left atrial appendage (LAA) occluder (LAAO) size determination by using transesophageal echocardiography (TEE) is limited by the structural complexity and wide anatomical variation of the LAA.ObjectiveThis study aimed to assess the accuracy of the LAAO size determination by implantation simulation by using a three-dimensional (3D)-printed model compared with the conventional method based on TEE.MethodsWe retrospectively reviewed patients with anatomically and physiologically properly implanted the Amplatzer Cardiac Plug and Amulet LAAO devices between January 2014 and December 2018 by using the final size of the implanted devices as a standard for size prediction accuracy. The use of 3D-printed model simulations in device sizing was compared with the conventional TEE-based method.ResultsA total of 28 cases with the percutaneous LAA occlusion were reviewed. There was a minimal difference [−0.11 mm; 95% CI (−0.93, 0.72 mm); P = 0.359] between CT-based reconstructed 3D images and 3D-printed left atrium (LA) models. Device size prediction based on TEE measurements showed poor agreement (32.1%), with a mean difference of 2.3 ± 3.2 mm [95% CI (−4.4, 9.0)]. The LAAO sizing by implantation simulation with 3D-printed models showed excellent correlation with the actually implanted LAAO size (r = 0.927; bias = 0.7 ± 2.5). The agreement between the 3D-printed and the implanted size was 67.9%, with a mean difference of 0.6 mm [95% CI (−1.9, 3.2)].ConclusionThe use of 3D-printed LA models in the LAAO size determination showed improvement in comparison with conventional 2D TEE method.

Left atrial appendage occlusion: On the need of a numerical model to simulate the implant procedure

“…The support of numerical tools leads to an even more patient‐centric intervention and allows for improvement and prediction of procedural outcomes. In this light, positive impacts on the patient's health can be obtained 15–23 …”

“…In this light, positive impacts on the patient's health can be obtained. [15][16][17][18][19][20][21][22][23] Namely, only two studies focusing on the device deployment phase are reported in the literature, given the fact that most of the computational investigations are devoted to the left atrium hemodynamics before, [24][25][26] or after the LAA closure. [27][28][29] As regards computational structural modeling of LAAO, the platform developed by FEOPS company (HEARTguide) based on finite element analyses (FEA) has been recognized as a medical device and suggested as a valid planning tool for comparing different possible LAAO procedures (i.e., positioning of the access/delivery system with respect to the LAA ostium) and selecting the most effective in terms of safe outcomes (no DP into the atrium, good device apposition on the LAA wall and complete LAA occlusion).…”

One‐stop procedure of “Atrial fibrillation radiofrequency ablation + left atrial appendage closure” guided by 3D printing technology: A case report

“…William D. Kim, Iksung Cho et al. retrospectively analyzed 28 cases of percutaneous LAA occlusion and concluded that the LAAO size determination by using simulation with 3D‐printed models of the LA showed improved accuracy compared with conventional methods based on 2D transesophageal echocardiography (TEE) 5 . Through rehearsal simulations of 10 patients using the phantom, Dayeong Hong, Sojin Moon et al.…”

Domain expert evaluation of advanced visual computing solutions and 3D printing for the planning of the left atrial appendage occluder interventions

“…Adaptation of 3D printing in clinical care and procedural planning has already demonstrated a reduction in early operator learning curve or in centers without previous experience on transcatheter interventions[ 2 , 15 - 17 ]. Several studies have evaluated the added value of 3D-printed models for training and planning of LAAO interventions[ 18 ]. However, Conti et al .…”