Hozman Marek, Herman Dalibor, Zemanek David, Fiser Ondrej, Vrba David, Poloczek Martin, Varvarovsky Ivo, Obona Peter, Pokorny Tomas, Osmancik Pavel
Cardiocenter, Third Faculty of Medicine, University Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic.
Second Department of Internal Medicine, Charles University, Prague, Czech Republic.
Catheter Cardiovasc Interv. 2023 Dec;102(7):1331-1340. doi: 10.1002/ccd.30867. Epub 2023 Oct 19.
The presented study investigates the application of bi-arterial 3D printed models to guide transseptal puncture (TSP) in left atrial appendage closure (LAAC).
The objectives are to (1) test the feasibility of 3D printing (3DP) for TSP guidance, (2) analyse the distribution of the optimal TSP locations, and (3) define a CT-derived 2D parameter suitable for predicting the optimal TSP locations.
Preprocedural planning included multiplanar CT reconstruction, 3D segmentation, and 3DP. TSP was preprocedurally simulated in vitro at six defined sites. Based on the position of the sheath, TSP sites were classified as optimal, suboptimal, or nonoptimal. The aim was to target the TSP in the recommended position during the procedure. Procedure progress was assessed post hoc by the operator.
Of 68 screened patients, 60 patients in five centers (mean age of 74.68 ± 7.64 years, 71.66% males) were prospectively analyzed (3DP failed in one case, and seven patients did not finally undergo the procedure). In 55 patients (91.66%), TSP was performed in the optimal location as recommended by the 3DP. The optimal locations for TSP were postero-inferior in 45.3%, mid-inferior in 45.3%, and antero-inferior in 37.7%, with a mean number of optimal segments of 1.34 ± 0.51 per patient. When the optimal TSP location was achieved, the procedure was considered difficult in only two (3.6%) patients (but in both due to complicated LAA anatomy). Comparing anterior versus posterior TSP in 2D CCT, two parameters differed significantly: (1) the angle supplementary to the LAA ostium and the interatrial septum angle (160.83° ± 9.42° vs. 146.49° ± 8.67°; p = 0.001), and (2) the angle between the LAA ostium and the mitral annulus (95.02° ± 3.73° vs. 107.38° ± 6.76°; p < 0.001), both in the sagittal plane.
In vitro TSP simulation accurately determined the optimal TSP locations for LAAC and facilitated the procedure. More than one-third of the optimal TSP sites were anterior.
本研究探讨双动脉三维打印模型在左心耳封堵术（LAAC）中引导经房间隔穿刺（TSP）的应用。
目标是（1）测试三维打印（3DP）用于TSP引导的可行性，（2）分析最佳TSP位置的分布，以及（3）定义一个适合预测最佳TSP位置的CT衍生二维参数。
术前规划包括多平面CT重建、三维分割和3DP。术前在六个确定的部位进行体外TSP模拟。根据鞘管的位置，TSP部位分为最佳、次优或非最佳。目标是在手术过程中将TSP定位在推荐位置。术后由操作者评估手术进展情况。
在68例筛查患者中，对五个中心的60例患者（平均年龄74.68±7.64岁，男性占71.66%）进行了前瞻性分析（3DP在1例中失败，7例患者最终未接受手术）。在55例患者（91.66%）中，TSP在3DP推荐的最佳位置进行。TSP的最佳位置在后下占45.3%，中下占45.3%，前下占37.7%，每位患者最佳节段的平均数为1.34±0.51。当达到最佳TSP位置时，仅2例（3.6%）患者的手术被认为困难（但均因左心耳解剖结构复杂）。在二维CCT中比较前位与后位TSP，两个参数有显著差异：（1）左心耳开口与房间隔夹角的补角（160.83°±s9.42°对146.49°±8.67°；p=0.001），以及（2）左心耳开口与二尖瓣环之间的夹角（95.02°±3.73°对107.38°±6.76°；p<0.001），均在矢状面。
体外TSP模拟准确确定了LAAC的最佳TSP位置并促进了手术。超过三分之一的最佳TSP部位在前位。
