Tarabanis Constantine, Klapholz Jonah, Zahid Sohail, Jankelson Lior
Leon H. Charney Division of Cardiology, NYU Langone Health, New York University Grossman School of Medicine, New York, New York, USA.
J Cardiovasc Electrophysiol. 2022 Nov;33(11):2367-2374. doi: 10.1111/jce.15658. Epub 2022 Sep 7.
The placement of a left atrial appendage occlusion (LAAO) device can be a technically challenging transcatheter-based procedure. Key challenges include accurate pre-procedural device sizing and proper device positioning at the LAA ostium to ensure sufficient device anchoring and avoid peri-device leaks. To address these challenges, 3D printing (3DP) of LAA models has recently emerged in the literature, first being described in 2015. We present a review of the benefits and drawbacks of employing this technology for LAAO procedures. Pre-procedurally the use of 3DP can consistently and accurately determine LAAO device size over standard of care approaches. Intra-procedurally 3DP's impact entailed a statistically significant decrease in the number of devices used per procedure, as well as in the fluoroscopic time and dose. Post-procedurally, there is some evidence that 3DP could reduce the rate of peri-device leaks, with limited data on its effect on complication rates. Based on existing evidence, we recommend the focused application of 3DP to cases of complex LAA anatomy and for the training of proceduralists. Lastly, we address the emergence of next generation LAAO devices and AR/VR systems that could limit even this narrow window of clinical benefit afforded by 3DP.
左心耳封堵（LAAO）装置的植入是一项技术要求较高的经导管操作。主要挑战包括术前准确的装置尺寸测量以及在左心耳开口处正确放置装置，以确保装置充分锚定并避免装置周围渗漏。为应对这些挑战，左心耳模型的三维打印（3DP）技术最近在文献中出现，首次描述于2015年。我们对在LAAO操作中应用该技术的利弊进行了综述。术前，与标准护理方法相比，使用3DP能够持续且准确地确定LAAO装置的尺寸。术中，3DP的影响包括每次操作使用的装置数量、透视时间和剂量在统计学上显著减少。术后，有证据表明3DP可降低装置周围渗漏率，但关于其对并发症发生率影响的数据有限。基于现有证据，我们建议将3DP重点应用于左心耳解剖结构复杂的病例以及用于培训操作人员。最后，我们探讨了下一代LAAO装置和AR/VR系统的出现，这些可能会限制3DP所带来的这一有限的临床益处。
