Patient-specific catheter shaping for the minimally invasive closure of the left atrial appendage

  • Eva C. Graf
  • Ilka Ott
  • Julian Praceus
  • Felix Bourier
  • Tim C. Lueth
Original Article
  • 33 Downloads

Abstract

Purpose

The minimally invasive closure of the left atrial appendage is a promising alternative to anticoagulation for stroke prevention in patients suffering from atrial fibrillation. One of the challenges of this procedure is the correct positioning and the coaxial alignment of the tip of the catheter sheath to the implant landing zone.

Method

In this paper, a novel preoperative planning system is proposed that allows patient-individual shaping of catheters to facilitate the correct positioning of the catheter sheath by offering a patient-specific catheter shape. Based on preoperative three-dimensional image data, anatomical points and the planned implant position are marked interactively and a patient-specific catheter shape is calculated if the standard catheter is not considered as suitable. An approach to calculate a catheter shape with four bends by maximization of the bending radii is presented. Shaping of the catheter is supported by a bending form that is automatically generated in the planning program and can be directly manufactured by using additive manufacturing methods.

Results

The feasibility of the planning and shaping of the catheter could be successfully shown using six data sets. The patient-specific catheters were tested in comparison with standard catheters by physicians on heart models. In four of the six tested models, the participating physicians rated the patient-individual catheters better than the standard catheter.

Conclusion

The novel approach for preoperatively planned and shaped patient-specific catheters designed for the minimally invasive closure of the left atrial appendage could be successfully implemented and a feasibility test showed promising results in anatomies that are difficult to access with the standard catheter.

Keywords

Patient-individual Catheter shape Catheter bending Left atrial appendage occlusion Automated construction 

Notes

Acknowledgements

The authors would like to thank the physicians of the German Heart Center Munich for participating in the evaluation experiment and their colleagues at the Institute of Micro Technology and Medical Device Technology at the Technical University of Munich, especially Yannick Krieger and Ismail Kuru, for their support.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

For this type of study, formal consent is not required.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© CARS 2018

Authors and Affiliations

  • Eva C. Graf
    • 1
  • Ilka Ott
    • 2
  • Julian Praceus
    • 1
  • Felix Bourier
    • 2
  • Tim C. Lueth
    • 1
  1. 1.Institute of Micro Technology and Medical Device TechnologyGarchingGermany
  2. 2.German Heart Center MunichMunichGermany

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