Key result
Rehearsal simulation using patient-specific 3D-printed left atrium phantoms accurately predicted the exact left atrial appendage occlusion device size used in the actual procedure for all 10 patients.
Why the study?
Selection of device size for left atrial appendage occlusion is challenging due to variable anatomy, prompting evaluation of patient-specific 3D-printed phantoms for pre-procedural sizing.
Does pre-procedure simulation with 3D-printed phantoms accurately predict device size for left atrial appendage occlusion?
Observational (n=10)
No
Does pre-procedure simulation with 3D-printed phantoms accurately predict device size for left atrial appendage occlusion?
Patient-specific 3D-printed phantoms based on CTA can accurately predict the required device size for left atrial appendage occlusion prior to the procedure.
Answers are grounded in this paper and cite their sources.
May support 3D-printed phantoms for LAAO sizing; leaves open need for larger prospective validation.
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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Hong et al. (2022) conducted an observational in Atrial fibrillation requiring left atrial appendage occlusion (n=10). Rehearsal simulation with patient-specific 3D-printed phantom vs. Actual procedure (no separate control group) was evaluated on Accuracy of predicted LAAO device size compared to actual inserted device size. Rehearsal simulation using patient-specific 3D-printed left atrium phantoms accurately predicted the exact left atrial appendage occlusion device size used in the actual procedure for all 10 patients.
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