Computed Tomography-Derived Three-Dimensional Printed Models versus Two-Dimensional Transesophageal Echocardiography for Left Atrial Appendage Occlusion Device Planning: A Systematic Review and Meta-Analysis.

Abstract

This systematic review and meta-analysis compared computed tomography (CT)-derived three-dimensional (3D) modeling versus two-dimensional transesophageal echocardiography (TEE) for left atrial appendage occluder (LAAO) device planning. LAAO device planning is commonly performed with TEE. However, procedures often require multiple devices and deployments due to inaccurate sizing from TEE. The use of CT three-dimensional (3D) models for LAAO device planning may improve accuracy. Four clinical studies that reported procedural and clinical outcomes for CT-derived 3D modeling versus TEE for LAAO device planning were identified. End points were accurate device sizing, procedure failure, number of devices used per procedure, fluoroscopy time, and post-procedure leak. Risk ratio (RR) and mean difference (MD) with a 95% confidence interval (CI) were calculated by the Mantel-Haenszel and inverse variance methods. A total of 166 participants were included. When compared with conventional imaging, the use of 3D printed models was associated with less fluoroscopy time (MD -6.98 minutes, 95% CI -12.68 to -1.28, p=0.02) and lower risk of occluder device peri-prosthetic leak (RR 0.23, 95% CI 0.07-0.73, p=0.01) for LAAO. There were signals towards lower number of devices per procedure (MD -0.56 devices, 95% CI -1.16-0.05, p=0.07) and less total procedure time (MD -13.50 minutes, 95% CI -28.14-1.14, p=0.07) with printed modeling for LAAO. There was no difference between modalities in rates of procedure failure. CT-derived 3D printed models for LAAO device planning may offer the advantages of lower LAAO device peri-prosthetic leak and less fluoroscopy time when compared with conventional TEE guidance.