3D-printed heart model to guide LAA closure: useful in clinical practice?
- 189 Downloads
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.
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.
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.
P3DPM allowed us to simulate the LAA closure procedure and thus helped to identify the best Amulet size and position within the LAA.
• 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.
KeywordsAtrial appendage Atrial fibrillation 3D printing Personalized 3D-printed models New emerging technology
Left atrial appendage
Personalized 3D-printed model
This work was presented at the last TCT meeting in Denver.
GEcor Fondation (foundation for cardiology research at the cardiology division at the University Hospital of Geneva). Some of the devices were provided by St. Jude Medical; some were recuperated after a mis-sizing
Compliance with ethical standards
The scientific guarantor of this publication is Jean-Paul Vallée.
Conflict of interest
The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.
Statistics and biometry
No complex statistical methods were necessary for this paper.
Written informed consent was obtained from all subjects (patients) in this study.
Institutional review board approval was obtained.
• diagnostic or prognostic study
• performed at one institution
(M4V 9549 kb)
- 2.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–e1039Google Scholar
- 3.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
- 4.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 127:720–729CrossRefPubMedGoogle Scholar
- 5.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 12:2083–2091CrossRefPubMedGoogle Scholar
- 7.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–D353CrossRefPubMedPubMedCentralGoogle Scholar
- 9.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 23:87–93CrossRefPubMedGoogle Scholar
- 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
- 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 123:417–424CrossRefPubMedGoogle Scholar
- 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 135:255–261CrossRefPubMedGoogle Scholar