Virtual reality utilization for left atrial appendage occluder device size prediction

Tejman‐Yarden, Shai; Freidin, Dor; Nagar, Netanel; Parmet, Yisrael; Abed, Muhamed; Vazhgovsky, Oliana; Yogev, David; Ganchrow, Dov; Mazor-Drey, Efrat; Chatterji, Sumit; Beinart, Roy; Barbash, Israel M.; Guetta, Victor; Goitein, Orly

doi:10.1016/j.heliyon.2023.e14790

Cited by 6 publications

(3 citation statements)

References 31 publications

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“…To prepare suitable occluder before LAA surgery and reduce the occurrence of occluder detachment. 12 …”

Section: Discussionmentioning

confidence: 99%

Displacement of occluder after left atrial appendage closure: A case report

Lin,

Mao

2024

Clinical Case Reports

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Key Clinical MessageAtrial fibrillation is closely associated with thrombotic events. In non‐valvular atrial fibrillation, 90% of thrombi are formed by the left atrial appendage. Left atrial appendage occlusion (LAAC) can effectively prevent the detachment of left atrial appendage thrombus during atrial fibrillation, thereby reducing the risk of long‐term disability or death caused by thromboembolic events. However, the identification and management of complications in LAAC are also very important.AbstractThe efficacy and safety of left atrial appendage occlusion (LAAC) in preventing non‐valvular atrial fibrillation stroke have been confirmed by multiple randomized controlled and registered studies, and have been recommended by several guidelines for stroke prevention in patients with atrial fibrillation at high‐risk of stroke. We reported an 80‐year‐old male patient with persistent atrial fibrillation. The patient underwent left atrial appendage closure surgery due to high risk of embolism and bleeding. On the second day after surgery, echocardiography showed displacement of the left atrial appendage occluder. Immediately perform removal of left atrial appendage occlude and left atrial appendage occlusion on the same day, and the patient was discharged on the fifth day after surgery without any special circumstances. This case demonstrates the feasibility and important clinical significance of using interventional surgery to remove the left atrial appendage occluder after displacement in clinical practice.

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“…To prepare suitable occluder before LAA surgery and reduce the occurrence of occluder detachment. 12 …”

Section: Discussionmentioning

confidence: 99%

Displacement of occluder after left atrial appendage closure: A case report

Lin,

Mao

2024

Clinical Case Reports

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“…evaluated VR compared to TEE and MSCT in the performance of measurements at the level of the ostium prior to LAAC. They found that maximal ostium diameter measured in VR best predicted inserted device size ( 24 ). However, in the case of Amplatzer Amulet™ LAA occluder (Abbott, Illinois, United States), LZ dimensions are decisive for device choice in order to ensure a stable device position.…”

Section: Discussionmentioning

confidence: 99%

Left atrial appendage sizing for percutaneous closure in virtual reality—a feasibility study

Heidari,

Kanschik,

Erkens

et al. 2023

Front. Cardiovasc. Med.

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Background and aimsThe complex and highly variable three-dimensional anatomy of the left atrial appendage (LAA) makes planning and device sizing for interventional occlusion procedures (LAAC) challenging. Several imaging modalities [e.g. echocardiography, multi-slice computed tomography (MSCT)] are used for this purpose. Virtual reality (VR) is an emerging imaging technique to immerse into a three-dimensional left atrium and appendage, offering unprecedented options of visualization and measurement. This study aimed to investigate the feasibility, accuracy and reproducibility of visualizing the LAA in VR for preprocedural planning of LAAC.Methods and resultsTwenty-one patients (79 ± 7 years, 62% male) who underwent LAAC at University Hospital Düsseldorf were included in our study. A dedicated software generated three-dimensional VR models from preprocedural MSCT imaging data. Conventional measurements of LAA dimensions (ostium, landing zone and depth) using a commercially available software were compared to measurements in VR: MSCT and VR ostium min. (r = 0.93), max. (r = 0.80) and mean (r = 0.88, all p < 0.001) diameters as well as landing zone (LZ) min. (r = 0.84), max. (r = 0.86) and mean diameters (r = 0.90, all p < 0.001) showed strong correlations. Three-dimensional orientation was judged superior by physicians in VR compared to MSCT (p < 0.05).ConclusionVirtual reality visualization of the left atrium and appendage based on MSCT data is feasible and allows precise and reproducible measurements in planning of LAA occlusion procedures with enhanced 3D orientation. Further studies need to explore additional benefits of three-dimensional visualization for operators in preprocedural planning.

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“…They reported that the maximum diameter of the LZ measured by VR correlated better with the final device selection compared to CCT and TOE. 20 However, the role of VR also needs to be tested against the standard approach.…”

Section: Discussionmentioning

confidence: 99%

Transseptal puncture in left atrial appendage closure guided by 3D printing and multiplanar CT reconstruction

Hozman,

Herman,

Zemanek

et al. 2023

Cathet Cardio Intervent

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BackgroundThe presented study investigates the application of bi‐arterial 3D printed models to guide transseptal puncture (TSP) in left atrial appendage closure (LAAC).AimsThe objectives are to (1) test the feasibility of 3D printing (3DP) for TSP guidance, (2) analyse the distribution of the optimal TSP locations, and (3) define a CT‐derived 2D parameter suitable for predicting the optimal TSP locations.MethodsPreprocedural planning included multiplanar CT reconstruction, 3D segmentation, and 3DP. TSP was preprocedurally simulated in vitro at six defined sites. Based on the position of the sheath, TSP sites were classified as optimal, suboptimal, or nonoptimal. The aim was to target the TSP in the recommended position during the procedure. Procedure progress was assessed post hoc by the operator.ResultsOf 68 screened patients, 60 patients in five centers (mean age of 74.68 ± 7.64 years, 71.66% males) were prospectively analyzed (3DP failed in one case, and seven patients did not finally undergo the procedure). In 55 patients (91.66%), TSP was performed in the optimal location as recommended by the 3DP. The optimal locations for TSP were postero‐inferior in 45.3%, mid‐inferior in 45.3%, and antero‐inferior in 37.7%, with a mean number of optimal segments of 1.34 ± 0.51 per patient. When the optimal TSP location was achieved, the procedure was considered difficult in only two (3.6%) patients (but in both due to complicated LAA anatomy). Comparing anterior versus posterior TSP in 2D CCT, two parameters differed significantly: (1) the angle supplementary to the LAA ostium and the interatrial septum angle (160.83° ± 9.42° vs. 146.49° ± 8.67°; p = 0.001), and (2) the angle between the LAA ostium and the mitral annulus (95.02° ± 3.73° vs. 107.38° ± 6.76°; p < 0.001), both in the sagittal plane.ConclusionsIn vitro TSP simulation accurately determined the optimal TSP locations for LAAC and facilitated the procedure. More than one‐third of the optimal TSP sites were anterior.

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Virtual reality utilization for left atrial appendage occluder device size prediction

Cited by 6 publications

References 31 publications

Displacement of occluder after left atrial appendage closure: A case report

Displacement of occluder after left atrial appendage closure: A case report

Left atrial appendage sizing for percutaneous closure in virtual reality—a feasibility study

Transseptal puncture in left atrial appendage closure guided by 3D printing and multiplanar CT reconstruction

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