Abstract
BackgroundThe 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.ObjectiveThis 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.MethodsWe 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.ResultsA 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)].ConclusionThe use of 3D-printed LA models in the LAAO size determination showed improvement in comparison with conventional 2D TEE method.
Highlights
Atrial fibrillation (AF) is associated with about five fold increased risk of ischemic stroke and is responsible for 15% for all the strokes; it may lead to severe disability or even death 120 [1–3]
Transesophageal echocardiography (TEE)based two-dimensional (2D) imaging parameters including the diameter of landing zone, depth, orientation of the main anchoring lobe, and the number and origin of additional lobes have been used for the determination of the LAA occluders (LAAOs) device type and size [7, 9]
The study population consisted of 28 individuals with the successful LAAO implantation; mean age was 73 ± 11 years and 16 (57.1%) were male
Summary
Atrial fibrillation (AF) is associated with about five fold increased risk of ischemic stroke and is responsible for 15% for all the strokes; it may lead to severe disability or even death 120 [1–3]. There are patients with contraindications to anticoagulant therapy or recurring stroke during OAC treatment. For these cases, the epicardial or endocardial LAA closure has emerged as a valid alternative [4]. The percutaneous LAA occluders (LAAOs) are minimally invasive endocardial devices that have shown non-inferior effectiveness in stroke prevention with a marked reduction in bleeding risk [5–7]. Given the complexity and wide variation of the LAA structure, the current 2D TEE-based preimplantation assessment strategy shows limitations in device sizing accuracy and overall understanding of the three-dimensional (3D) LAA structure [4, 10]. 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
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