Key result
Patient-specific CT-based 3D printing models accurately predicted the implanted LAA closure device size in 95% of patients, whereas TEE would have undersized the device in 45%.
Why the study?
Does device sizing using CT-based 3D-printed models improve sizing accuracy compared to TEE in patients undergoing LAA closure?
Observational (n=22)
Does device sizing using CT-based 3D-printed models improve sizing accuracy compared to TEE in patients undergoing LAA closure?
Patient-specific CT-based 3D printing models accurately predict optimal device size and compression for LAA closure, potentially preventing the undersizing often seen with standard TEE.
May warrant consideration of CT-based 3D models for LAA sizing; leaves open whether this improves outcomes in prospective trials.
AIMS: Device sizing for LAA closure using transoesophageal echocardiography (TEE) can be challenging due to complex LAA anatomy. We investigated whether the use of 3D-printed left atrial appendage (LAA) models based on preprocedural computed tomography (CT) permits accurate device sizing. METHODS AND RESULTS: Twenty-two (22) patients (73±8 years, 55% male) with atrial fibrillation requiring anticoagulation at high bleeding risk underwent LAA closure (WATCHMAN device). Preprocedurally, LAA was sized by TEE and third-generation dual-source CT. Based on CT, 3D printing models of LAA anatomy were created for simulation of device implantation. Device compression was assessed in a CT scan of the 3D model with the implanted device. Implantation was successful in all patients. Mean LAA ostium diameter based on TEE was 22±4 mm and based on CT 25±3 mm (p=0.014). Predicted device size based on simulated implantation in the 3D model was equal to the device finally implanted in 21/22 patients (95%). TEE would have undersized the device in 10/22 patients (45%). Device compression determined in the 3D-CT model corresponded closely with compression upon implantation (16±3% vs. 18±5%, r=0.622, p=0.003). CONCLUSIONS: Patient-specific CT-based 3D printing models may assist device selection and prediction of device compression in the context of interventional LAA closure.
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Hell et al. (2017) conducted an observational in Atrial fibrillation requiring anticoagulation at high bleeding risk (n=22). 3D-printed LAA models based on preprocedural CT vs. Transoesophageal echocardiography (TEE) was evaluated on Predicted device size equal to the device finally implanted. Patient-specific CT-based 3D printing models accurately predicted the implanted LAA closure device size in 95% of patients, whereas TEE would have undersized the device in 45%.
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