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

  • Cardiac
  • Published:
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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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Abbreviations

2D:

2-dimensional

3D:

3-dimensional

CT:

Computed tomography

LAA:

Left atrial appendage

P3DPM:

Personalized 3D-printed model

STL:

Stereolithography

TEE:

Transesophageal echocardiography

References

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

    Article  CAS  Google Scholar 

  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–e1039

    Google 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 127:720–729

    Article  Google 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 12:2083–2091

    Article  Google Scholar 

  6. 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 77:700–706

    Article  Google 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–D353

    Article  Google Scholar 

  8. 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 17:642–646

    Article  Google 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 23:87–93

    Article  Google Scholar 

  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:e000627

    Article  Google 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

  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 4:514–523

    Article  Google Scholar 

  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 9:2329–2340

    Article  Google Scholar 

  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 14:36

    Article  Google Scholar 

  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 8:1935–1941

    Article  Google Scholar 

  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 374:534–542

    Article  CAS  Google Scholar 

  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 64:1–12

    Article  Google Scholar 

  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 123:417–424

    Article  Google Scholar 

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

    Article  Google Scholar 

  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 32:1495–1497

    Article  Google Scholar 

  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 10:1067–1070

    Article  Google Scholar 

  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–e1079

    Article  Google Scholar 

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

    Article  Google 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 135:255–261

    Article  Google Scholar 

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Acknowledgements

This work was presented at the last TCT meeting in Denver.

Funding

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

Author information

Author notes

  1. Anne-Lise Hachulla and Stéphane Noble contributed equally to this work.

Authors and Affiliations

  1. Division of Radiology, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1291, Geneva, Switzerland

    Anne-Lise Hachulla, Gabriel Guglielmi & Jean-Paul Vallée

  2. Department of Cardiology, University Hospitals of Geneva, Geneva, Switzerland

    Stéphane Noble & Hajo Müller

  3. Computer Science Center, Faculty of Science, Carouge, Switzerland

    Daniel Agulleiro

Authors
  1. Anne-Lise Hachulla
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  2. Stéphane Noble
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  3. Gabriel Guglielmi
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  4. Daniel Agulleiro
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  5. Hajo Müller
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  6. Jean-Paul Vallée
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Corresponding author

Correspondence to Anne-Lise Hachulla.

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Guarantor

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.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional review board approval was obtained.

Methodology

• retrospective

• diagnostic or prognostic study

• performed at one institution

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Hachulla, AL., Noble, S., Guglielmi, G. et al. 3D-printed heart model to guide LAA closure: useful in clinical practice?. Eur Radiol 29, 251–258 (2019). https://doi.org/10.1007/s00330-018-5569-x

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  • DOI: https://doi.org/10.1007/s00330-018-5569-x

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