Preliminary data from ‘LAA-Print French registry’: A large national multi-centric prospective registry evaluating a new preoperative approach based on 3D printed simulation in LAAC procedures

Abstract

3D-printing have demonstrated improving in LAAC device sizing, a reduce procedure time and number of prostheses employed per patient. Otherwise, LAAC procedures may be at risk if unfavourable anatomy and performed in frailly patients. Three hundred patients are expected to be included in LAA-Print French registry. Procedure time, success rate, number of prosthesis per procedure and complications will be compared to patients without 3D printing simulation. Cardiac CT prior to LAAO. Industrial Manufacture of 3D-printed LAA models including all LA cavity. Simulation on the basis of 3D printing models using specifics sheaths and prosthesis (Boston TM and AbbottR). Check of transseptal puncture site in order to avoid a misalignment. Risk ranking for failure of procedure: low/moderate/high based on 3D printing simulation. To improve the efficiency and safety of LAA closure. Nb of center: 15, 51 patients since January 2018. Procedure risk was classified: low risk in 60%, moderate 20% and high-risk 20%. Outcomes in low risk group: no prosthesis changes, operating time 35 (27–56 min), no leaks > 3 mm. In the group of moderated or high-risk: procedure failure occurred in 50%. Incidence of leaks > 5 mm was 40% and device misalignment occurred in 70%. The operating time was significantly prolonged 75 min (45–102). The rate of device change occurred in 60%. Factors that critically impacted the LAAO procedure's success were: retroversion of the LAA,marked elliptical shape of LAA ostium, protuberant pulmonary ridge, marked flat chicken wing shape, depth. 3D printing simulation: leads to enhanced communication between all key players. Allows a better transseptal puncture planning. Permits a tailored selection of the appropriate device. We identified a group at risk according to LA anatomy. In this group, 3D printing may accurately guide the procedure by carefully checking the trans septal puncture site and/or using specific catheter shape.