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European Radiology

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01-01-2019 | Cardiac

3D-printed heart model to guide LAA closure: useful in clinical practice?

Authors: Anne-Lise Hachulla, Stéphane Noble, Gabriel Guglielmi, Daniel Agulleiro, Hajo Müller, Jean-Paul Vallée

Published in: European Radiology | Issue 1/2019

Abstract

Objectives

Correct device sizing for left atrial appendage (LAA) closure remains challenging due to complex LAA shapes. The aim of our study was to investigative the utility of personalized 3D-printed models (P3DPM) of the LAA to guide device size selection.

Methods

Fifteen patients (75.4 ±8.5years) scheduled for LAA closure using an Amulet device underwent cardiac computed tomography (CT). The LAA was segmented by semiautomatic algorithms using Vitrea® software. A 1.5-mm LAA thick shell was exported in stereolithography format and printed using TangoPlus flexible material. Different Amulet device sizes on the P3DPM were tested. New P3DPM-CT with the device was acquired in order to appreciate the proximal disc sealing the LAA ostium and the compression of the distal lobe within the LAA. We predicted the device size with P3DPM and compared this with the device sizes predicted by transesophageal echocardiography (TEE) and CT as well as the device size implanted in patients.

Results

The device size predicted by 3D-TEE and CT corresponded to the implanted device size in 8/15 (53%) and 10/15 (67%), respectively. The predicted device size from the P3DPM was accurate in all patients, obtaining perfect contact with the LAA wall, without device instability or excessive compression. P3DPM-CT with the deployed device showed device deformation and positioning of the disk in relation to the pulmonary veins, allowing us to determine the best device size in all 15 cases.

Conclusion

P3DPM allowed us to simulate the LAA closure procedure and thus helped to identify the best Amulet size and position within the LAA.

Key Points

• A 3D-printed heart model allows to simulate the LAA closure procedure.

• A 3D-printed heart model allowed to identify the optimal Amulet size and position.

• 3D-printed heart models may contribute to reduce the Amulet implantation learning curve.

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Blackshear JL, Odell J (1996) Appendage obliteration to reduce stroke in cardiac surgical patients with atrial fibrillation. Ann Thorac Surg 61:755–759CrossRef

Saw J, Lopes JP, Reisman M, McLaughlin P, Nicolau S, Bezerra HG (2016) Cardiac computed tomography angiography for left atrial appendage closure. Can J Cardiol 32(1033):e1031–e1039

Matsuo Y, Neuzil P, Petru J et al (2016) Left atrial appendage closure under intracardiac echocardiographic guidance: feasibility and comparison with transesophageal echocardiography. J Am Heart Assoc 5(10). https://doi.org/10.1161/JAHA.116.003695

Reddy VY, Doshi SK, Sievert H et al (2013) Percutaneous left atrial appendage closure for stroke prophylaxis in patients with atrial fibrillation: 2.3-year follow-up of the PROTECT AF (Watchman Left Atrial Appendage System for Embolic Protection in Patients with Atrial Fibrillation) Trial. Circulation 127:720–729CrossRef

Al-Kassou B, Tzikas A, Stock F, Neikes F, Volz A, Omran H (2017) A comparison of two-dimensional and real-time 3D transoesophageal echocardiography and angiography for assessing the left atrial appendage anatomy for sizing a left atrial appendage occlusion system: impact of volume loading. EuroIntervention 12:2083–2091CrossRef

Park JW, Bethencourt A, Sievert H et al (2011) Left atrial appendage closure with Amplatzer cardiac plug in atrial fibrillation: initial European experience. Catheter Cardiovasc Interv 77:700–706CrossRef

Casu G, Gulizia MM, Molon G et al (2017) ANMCO/AIAC/SICI-GISE/SIC/SICCH Consensus Document: percutaneous occlusion of the left atrial appendage in non-valvular atrial fibrillation patients: indications, patient selection, staff skills, organisation, and training. Eur Heart J Suppl 19:D333–D353CrossRef

Pison L, Potpara TS, Chen J et al (2015) Left atrial appendage closure-indications, techniques, and outcomes: results of the European Heart Rhythm Association Survey. Europace 17:642–646CrossRef

Budge LP, Shaffer KM, Moorman JR, Lake DE, Ferguson JD, Mangrum JM (2008) Analysis of in vivo left atrial appendage morphology in patients with atrial fibrillation: a direct comparison of transesophageal echocardiography, planar cardiac CT, and segmented three-dimensional cardiac CT. J Interv Card Electrophysiol 23:87–93CrossRef

10.

Chow DH, Bieliauskas G, Sawaya FJ et al (2017) A comparative study of different imaging modalities for successful percutaneous left atrial appendage closure. Open Heart 4:e000627CrossRef

11.

Hell MM, Achenbach S, Yoo IS et al (2017) 3D printing for sizing left atrial appendage closure device: head-to-head comparison with computed tomography and transesophageal echocardiography. EuroIntervention. https://doi.org/10.4244/EIJ-D-17-00359

12.

Nucifora G, Faletra FF, Regoli F et al (2011) Evaluation of the left atrial appendage with real-time 3-dimensional transesophageal echocardiography: implications for catheter-based left atrial appendage closure. Circ Cardiovasc Imaging 4:514–523CrossRef

13.

Wang DD, Eng M, Kupsky D et al (2016) Application of 3-dimensional computed tomographic image guidance to WATCHMAN implantation and impact on early operator learning curve: single-center experience. JACC Cardiovasc Interv 9:2329–2340CrossRef

14.

Yosefy C, Azhibekov Y, Brodkin B, Khalameizer V, Katz A, Laish-Farkash A (2016) Rotational method simplifies 3-dimensional measurement of left atrial appendage dimensions during transesophageal echocardiography. Cardiovasc Ultrasound 14:36CrossRef

15.

Spencer RJ, DeJong P, Fahmy P et al (2015) Changes in left atrial appendage dimensions following volume loading during percutaneous left atrial appendage closure. J Am Coll Cardiol Intv 8:1935–1941CrossRef

16.

Holmes DR, Reddy VY, Turi ZG et al (2009) Percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrillation: a randomised non-inferiority trial. Lancet 374:534–542CrossRef

17.

Holmes DR Jr, Kar S, Price MJ et al (2014) Prospective randomized evaluation of the Watchman Left Atrial Appendage Closure device in patients with atrial fibrillation versus long-term warfarin therapy: the PREVAIL trial. J Am Coll Cardiol 64:1–12CrossRef

18.

Reddy VY, Holmes D, Doshi SK, Neuzil P, Kar S (2011) Safety of percutaneous left atrial appendage closure: results from the Watchman Left Atrial Appendage System for Embolic Protection in Patients with AF (PROTECT AF) clinical trial and the Continued Access Registry. Circulation 123:417–424CrossRef

19.

Otton JM, Spina R, Sulas R et al (2015) Left atrial appendage closure guided by personalized 3D-printed cardiac reconstruction. JACC Cardiovasc Interv 8:1004–1006CrossRef

20.

Obasare E, Melendres E, Morris DL, Mainigi SK, Pressman GS (2016) Patient specific 3D print of left atrial appendage for closure device. Int J Card Imaging 32:1495–1497CrossRef

21.

Bieliauskas G, Otton J, Chow DHF et al (2017) Use of 3-dimensional models to optimize pre-procedural planning of percutaneous left atrial appendage closure. JACC Cardiovasc Interv 10:1067–1070CrossRef

22.

Goitein O, Fink N, Guetta V et al (2017) Printed MDCT 3D models for prediction of left atrial appendage (LAA) occluder device size: a feasibility study. EuroIntervention 13:e1076–e1079CrossRef

23.

Li H, Qingyao B et al (2017) Application of 3D printing technology to left atrial appendage occlusion. Int J Cardiol 231:258–263CrossRef

24.

Vaquerizo B, Escabias C, Dubois D, Gomez G, Barreiro-Perez M, Cruz-Gonzalez I (2017) Patient-specific 3D-printed cardiac model for percutaneous left atrial appendage occlusion. Rev Esp Cardiol. https://doi.org/10.1016/j.rec.2017.05.028

25.

Liu P, Liu R, Zhang Y, Liu Y, Tang X, Cheng Y (2016) The value of 3D printing models of left atrial appendage using real-time 3D transesophageal echocardiographic data in left atrial appendage occlusion: applications toward an era of truly personalized medicine. Cardiology 135:255–261CrossRef

Title: 3D-printed heart model to guide LAA closure: useful in clinical practice?
Authors: Anne-Lise Hachulla
Stéphane Noble
Gabriel Guglielmi
Daniel Agulleiro
Hajo Müller
Jean-Paul Vallée
Publication date: 01-01-2019
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 1/2019
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-018-5569-x

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

3D-printed heart model to guide LAA closure: useful in clinical practice?

Abstract

Objectives

Methods

Results

Conclusion

Key Points

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusion

Key Points

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