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

  • Anne-Lise Hachulla
  • Stéphane Noble
  • Gabriel Guglielmi
  • Daniel Agulleiro
  • Hajo Müller
  • Jean-Paul Vallée
Cardiac

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.

Keywords

Atrial appendage Atrial fibrillation 3D printing Personalized 3D-printed models New emerging technology 

Abbreviations

2D

2-dimensional

3D

3-dimensional

CT

Computed tomography

LAA

Left atrial appendage

P3DPM

Personalized 3D-printed model

STL

Stereolithography

TEE

Transesophageal echocardiography

Notes

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

Compliance with ethical standards

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

Supplementary material

ESM 1

(M4V 9549 kb)

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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  1. 1.Division of RadiologyUniversity Hospitals of GenevaGenevaSwitzerland
  2. 2.Department of CardiologyUniversity Hospitals of GenevaGenevaSwitzerland
  3. 3.Computer Science Center, Faculty of ScienceCarougeSwitzerland

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