Role of CT imaging in left atrial appendage occlusion for the WATCHMAN™ device

Kaafarani, Mirna; Saw, Jacqueline; Daniels, Matthew J.; Song, Thomas; Rollet, Marianne; Kesinovic, Sanel; Lamorgese, Tony; Kubiak, Kati; Qi, Zhihua; Pantelic, Milan; O’Neill, W. Charles; Wang, Dee Dee

doi:10.21037/cdt.2019.12.01

Cited by 27 publications

(16 citation statements)

References 19 publications

(19 reference statements)

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“…Although CCTA has emerged as an alternative to TEE for peri‐procedural planning and post‐procedural evaluation of LAAC, TEE is the most used imaging modality for LAAC procedures and is often done under general anesthesia 21,22 . TEE provides high temporal and spatial resolution images of the LAA and interatrial septum as well as other intracardiac structures.…”

Section: Discussionmentioning

confidence: 99%

“…20 Although CCTA has emerged as an alternative to TEE for periprocedural planning and post-procedural evaluation of LAAC, TEE is the most used imaging modality for LAAC procedures and is often done under general anesthesia. 21,22 TEE provides high temporal and spatial resolution images of the LAA and interatrial septum as well as other intracardiac structures. In addition to the periprocedural TEE, multiple pre and postprocedure TEE studies are performed to assess and evaluate the anatomical candidacy, device seal, and devicerelated thrombus.…”

Section: Discussionmentioning

confidence: 99%

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In‐hospital outcomes of transesophageal versus intracardiac echocardiography guided left atrial appendage closure

Morcos

Megaly

Saad

et al. 2022

Cathet Cardio Intervent

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Background: Transesophageal echocardiogram (TEE) is the preferred imaging modality to guide transcatheter left atrial appendage closure (LAAC). Intracardiac echocardiography (ICE) has evolved as a less invasive alternative to TEE. Several observational studies have shown similar success rates and perioperative complications between TEE and ICE for LAAC.Objectives: We sought to examine the temporal trends and patient characteristics of TEE versus ICE use in LAAC using a national database. We also evaluated hospital outcomes including periprocedural complications, mortality, and length of hospital stay.Methods: This is a retrospective analysis of data from the National Readmission Database, collected from 2016 to 2018. The primary outcome was major adverse events (MAE) defined as in-hospital mortality, cardiac arrest, pericardial effusion with or without tamponade, pericardiocentesis or window pericardiocentesis and pericardial window, pericardial effusion and tamponade, and hemorrhage requiring transfusion.Results: Trend analysis showed that TEE-guided LAAC increased from 96.6% in 2016 to 98.4% in 2018 (relative increase, 1.9%), while ICE-guided LAAC decreased from 3.4% to 1.6% during the same period (relative decrease, 53%, p for trend = 0.08). In the unmatched cohorts, the MAE was significantly lower in TEE-guided LAAC compared to ICE-guided LAAC (6.5% vs. 9.3%, p = 0.022). In the propensity score matching analysis, MAE remained significant (5.6% vs. 9.4%, p < 0.001). The incidence of pericardial effusion with or without tamponade remained significantly lower in the TEE group (2.3% vs. 5.8%, p < 0.001). Length of stay (3.4 vs. 1.9 days, p < 0.001) and hospitalization cost ($34,826 vs. $20,563, p < 0.001) remained significantly lower for TEE-guided LAAC.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

In‐hospital outcomes of transesophageal versus intracardiac echocardiography guided left atrial appendage closure

Morcos

Megaly

Saad

et al. 2022

Cathet Cardio Intervent

View full text Add to dashboard Cite

show abstract

“…Furthermore, Ko et al developed a patient-specific breast surgery guide model for surgery planning and resident and patient education 37 . In addition, there have been 3D printing studies related to LAAO 38 – 40 . However, due to the limitations of 3D printing materials, it was difficult to implement a phantom with properties similar to the handling of a cardiologist during an actual procedure.…”

Section: Introductionmentioning

confidence: 99%

Rehearsal simulation to determine the size of device for left atrial appendage occlusion using patient-specific 3D-printed phantoms

Hong

Moon

Cho

et al. 2022

Sci Rep

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Left atrial appendage (LAA) occlusion (LAAO) is used to close the finger-like extension from the left atrium with occlusion devices to block the source of thrombosis. However, selection of the devices size is not easy due to various anatomical changes. The purpose of this study is patient-specific, computed tomography angiography (CTA)-based, three-dimensionally (3D) printed LAAO phantoms were applied pre-procedure to determine the size. Ten patients were enrolled prospectively in March 2019 and December 2020. The cardiac structure appearing in CTA was first segmented, and the left atrium and related structures in the LAAO procedure were modeled. The phantoms were fabricated using two methods of fused deposition modeling (FDM) and stereolithography (SLA) 3D printers with thermoplastic polyurethane (TPU) and flexible resin materials and evaluated by comparing their physical and material properties. The 3D-printed phantoms were directly used to confirm the shape of LAA, and to predict the device size for LAAO. In summary, the shore A hardness of TPU of FDM was about 80–85 shore A, and that of flexible resin of SLA was about 50–70 shore A. The measurement error between the STL model and 3D printing phantoms were 0.45 ± 0.37 mm (Bland–Altman, limits of agreement from − 1.8 to 1.6 mm). At the rehearsal, the estimations of device sizes were the exact same with those in the actual procedures of all 10 patients. In conclusion, simulation with a 3D-printed left atrium phantom could be used to predict the LAAO insertion device size accurately before the procedure.

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“…Furthermore, Ko et al developed a patient-speci c breast surgery guide model for surgery planning and resident and patient education 38 . In addition, there have been 3D printing studies related to LAAO [39][40][41] . However, due to the limitations of 3D printing materials, it was di cult to implement a phantom with properties similar to the handling of a cardiologist during an actual procedure.…”

Section: Introductionmentioning

confidence: 99%

Rehearsal Simulation to Determine the Size of Device for Left Atrial Appendage Occlusion Using Patient-Specific 3D-Printed Phantoms Based on CT Images

Hong

Moon

Cho

et al. 2022

Preprint

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Left atrial appendage (LAA) occlusion (LAAO) is used to close the entrance of the left atrium with occlusion devices to block the cause of thrombosis. However, selection of the devices size is not easy due to various anatomical changes. The purpose of this study is patient-specific, computed tomography angiography (CTA)-based, three-dimensionally (3D) printed LAAO phantoms were applied pre-procedure to determine the size. Ten patients were enrolled prospectively in March 2019 and December 2020. The cardiac structure appearing in CTA was first segmented, and the left atrium and related structures in the LAAO procedure were modeled. The phantoms were fabricated using two methods of fused deposition modeling (FDM) and stereolithography (SLA) 3D printers with thermoplastic polyurethane (TPU) and flexible resin materials and evaluated by comparing their physical and material properties. The 3D-printed phantoms were directly used to confirm the shape of LAA, and to predict the device size for LAAO. In summary, the shore A hardness of TPU of FDM was about 80–85 shore A, and that of flexible resin of SLA was about 50–70 shore A. The measurement error between the STL model and 3D printing phantoms were 0.45 ± 0.37 mm (Bland-Altman, limits of agreement from − 1.8 to 1.6 mm). At the rehearsal, the estimations of device sizes were the exact same with those in the actual procedures of all 10 patients. In conclusion, simulation with a 3D-printed left atrium phantom could be used to predict the LAAO insertion device size accurately before the procedure.

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Role of CT imaging in left atrial appendage occlusion for the WATCHMAN™ device

Cited by 27 publications

References 19 publications

In‐hospital outcomes of transesophageal versus intracardiac echocardiography guided left atrial appendage closure

In‐hospital outcomes of transesophageal versus intracardiac echocardiography guided left atrial appendage closure

Rehearsal simulation to determine the size of device for left atrial appendage occlusion using patient-specific 3D-printed phantoms

Rehearsal Simulation to Determine the Size of Device for Left Atrial Appendage Occlusion Using Patient-Specific 3D-Printed Phantoms Based on CT Images

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