Establishment and assessment of an LAA occlusion preoperative simulation system based on 3D transesophageal echocardiography and 3D printing

Abstract

Objective To create an left atrial appendage(LAA) occlusion preoperative simulation system by three dimensional transesophageal echocardiography(3DTEE) and three dimensional printing(3DP), and simulate the process of LAA occlusion including the selection and deployment of devices, leaks around devices and the compression rate of the devices in vitro. Methods Fifteen cases of LAA occlusion in patients with atrial fibrillation were selected in this study. Preoperative and intraoperative TEE was performed to acquire the volume data of LAA. Replicas of LAAs were created by 3DP. Then the simulation system was created by 3DTEE and the models. The models were scanned by 3DTEE to evaluate the accuracy of models, leaks around devices and the compression rate of the devices.The results were compared with intraoperative measurements. Results 3DP models of 15 patients were created based on the 3DTEE data. There was no significant difference in the values of measurements between models and cases in vivo by 3DTEE and there were agreements between these two methods. The compression rate of devices was higher in models than in case (P=0.04). Compression rate in models correlated with that in cases (r=0.949, P<0.01). Four cases were observed with leaks in 3DP models and 6 cases were observed with leaks intraoperatively, the Kappa value of agreement was 0.706. Conclusions Preoperative exercise and evaluation of LAA occlusion can be acquired by the preoperative simulation system based on 3DTEE and 3DP, which can be an important supplement for preoperative preparation. Key words: Echocardiography, transesophageal, three-dimensional; Three-dimensional printing; Left atrial appendage