Key result
Preprocedural simulation using 3D-printed left atrial appendage models improved device sizing agreement with the actually implanted size to 67.9%, compared to 32.1% with conventional 2D transesophageal echocardiography.
Why the study?
Two-dimensional TEE-based LAA occluder size determination is limited by structural complexity and wide anatomical variation of the LAA.
Does device size determination using 3D-printed left atrium models improve sizing accuracy compared to conventional 2D TEE in patients undergoing LAAO?
Observational (n=28)
Blinded assessors
No
Does device size determination using 3D-printed left atrium models improve sizing accuracy compared to conventional 2D TEE in patients undergoing LAAO?
Absolute Event Rate: 67.9% vs 32.1%
Preprocedural simulation using 3D-printed left atrial models significantly improves the accuracy of LAAO device sizing compared to conventional 2D TEE.
May improve device sizing accuracy in LAA occlusion; leaves open effects on procedural success or outcomes.
Background The 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. Objective This 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. Methods We 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. Results A 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)]. Conclusion The use of 3D-printed LA models in the LAAO size determination showed improvement in comparison with conventional 2D TEE method.
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Kim et al. (2022) conducted an observational in Atrial fibrillation requiring left atrial appendage occlusion (n=28). 3D-printed model simulation vs. 2D TEE-based method was evaluated on Agreement between predicted device size and actually implanted device size. Preprocedural simulation using 3D-printed left atrial appendage models improved device sizing agreement with the actually implanted size to 67.9%, compared to 32.1% with conventional 2D transesophageal echocardiography.
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