Author + information
- Vlad Ciobotaru1
Despite an increasing rate of successful implantationsof LAAo devices, correct sizing and optimal device positioning remain a challenge. 3D printing has capability to create a highly accurate model of any structure and may be a useful approach for entire LAA anatomy, optimizing device size testing before LAAo.
70 consecutive patients (CHA2DS2-Vasc score=4.5±1.5) with a LAAo procedure with AmuletTM(St. Jude Medical, St Paul, MN, USA) and a pre- and post-procedure cardiac CT, were included in three institutions between Feb 2014 and Mars 2017. A clinical follow-up was effective for 17±10 months. Cavity segmentation was performed automatically based on CT Dicom data and manually adjusted to include the entire left atrium, then converted to a STL file and 3D printed with high resolution 50microns. (fig)
peri-device leaks >5mm occurred in 33% of patients. A mismatch between the model predicted size and the device used was a major predictor of peri-device leaks (AUC=0.85) with Predictive Positive Value (PPV)=82% and NPV=89% compared with CT sizing and TEE sizing (AUC=0.58 and 0.57, respectively p<0.001). An off-axis positioning was observed in 24% of patients. Predictive factors were a large pulmonary vein ridge and an inadequate transeptal site puncture. Complications rate was correlated with the mismatch between size used and printed model: odds ratio of 4.1 (1.5-12.7; p=0.01).
|Variable||AUC for peridevice Leakage||p-value||Se||Sp||PPV||NPV|
|3D-Printed Sizing||0.85 (0.75-0.95)||-||78%||91%||82%||89%|
|CT Sizing||0.58 (0.45-0.70)||<0.001||44%||71%||43%||71%|
|TEE sizing||0.57 (0.43-0.69)||<0.001||43%||69%||47%||66%|
|LAA type “chicken wing”||0.44 (0.31-0.56)||<0.001||52%||36%||28%||61%|
|LZ Eccentricity||0.66 (0.50 -0.82)||0.02||61%||66%||47%||77%|
3D-printed patient-specific LA model allow more accurate sizing than TEE and CT measurements. It permits a pivotal training, device testing and evaluation of optimal trans-septal puncture site with potentially important implications in minimizing procedure-related complications.
STRUCTURAL: Left Atrial Appendage Exclusion