Kahlam Jasneel S, Savinova Olga V, Shamilov Don D, Tran John, Borgmann Jodie, Tran Trinh, Jean Nathan, Lo David F
Internal Medicine, Stony Brook Southampton, Southampton, USA.
Basic Sciences, New York Institute of Technology, College of Osteopathic Medicine (NYITCOM), Old Westbury, USA.
Cureus. 2025 Apr 10;17(4):e82043. doi: 10.7759/cureus.82043. eCollection 2025 Apr.
In recent years, the clinical application of three-dimensional (3D) printing technology has shown great potential in surgical planning. The left atrial appendage (LAA) is a key site for thrombus formation in nonvalvular atrial fibrillation (NVAF), increasing the risk of stroke. One recent application of this technology is for LAA occlusion, a procedure used to seal the LAA and prevent the formation of systemic thromboembolism associated with NVAF in patients with contraindications for oral anticoagulation therapy. In this systematic review, the use of 3D printing for device sizing during the planning of LAA occlusion procedures was evaluated through a literature search using the following keywords: ("Left atrial appendage" OR "LAA" or "intra-atrial mass" OR "left atrial mass" ) AND ("3D printing" OR "additive manufacturing" OR "rapid prototyping" OR "computer-aided design" OR "CAD" OR "bioprinting") AND ("occlusion" OR "closure" OR "device sizing" OR "atrial fibrillation"). After data extraction, 16 studies reported using 3D printing, prospectively or retrospectively, to estimate the accuracy of LAA device sizing and/or deployment. These studies demonstrated that 3D-printed models can improve anatomical measurements and allow for improved device sizing and implantation compared to standard-of-care imaging-assisted procedural planning. Of the articles included in this review, two articles found a significant reduction in devices used per procedure (from 1.7 to 1.1 and 1.20 to 1.05, respectively), with shorter procedure times in the 3D-printed groups. Additionally, the 3D-printed models showed fewer devices deployed per procedure, perivascular leaks, and residual shunts. Additionally, one article found fewer perivascular leaks in the 3D group (one vs. four in controls), and one article showed no residual shunts in the 3D group compared to 14.29% in controls. Although the 16 studies included in this review demonstrate the value of 3D printing in LAA occlusion procedures, the findings underscore the need for larger, multicenter studies to further quantify its clinical benefits, particularly in improving procedural planning and reducing complications in the intravascular treatment of LAA thrombosis in NVAF. Future research should focus on multicenter trials, larger cohorts, and testing 3D-printed occlusion devices for personalized treatments.
近年来，三维（3D）打印技术在临床手术规划中的应用显示出巨大潜力。左心耳（LAA）是非瓣膜性心房颤动（NVAF）患者血栓形成的关键部位，增加了中风风险。该技术最近的一个应用是用于LAA封堵，这是一种用于封闭LAA并预防口服抗凝治疗禁忌的NVAF患者发生系统性血栓栓塞的手术。在本系统评价中，通过使用以下关键词进行文献检索，评估了在LAA封堵手术规划期间使用3D打印进行器械尺寸确定的情况：（“左心耳”或“LAA”或“心房内肿物”或“左心房肿物”）与（“3D打印”或“增材制造”或“快速成型”或“计算机辅助设计”或“CAD”或“生物打印”）与（“封堵”或“闭合”或“器械尺寸确定”或“心房颤动”）。数据提取后，16项研究报告了前瞻性或回顾性地使用3D打印来估计LAA器械尺寸确定和/或部署的准确性。这些研究表明，与标准的影像辅助手术规划相比，3D打印模型可以改善解剖测量，并实现更好的器械尺寸确定和植入。在本综述纳入的文章中，两篇文章发现每个手术使用的器械数量显著减少（分别从1.7减少到1.1以及从(1.20)减少到1.05），3D打印组的手术时间更短。此外，3D打印模型显示每个手术部署的器械数量更少、血管周围渗漏更少以及残余分流更少。另外，一篇文章发现3D组的血管周围渗漏更少（1例对比对照组的4例），一篇文章显示3D组无残余分流，而对照组为(14.29%)。尽管本综述纳入的16项研究证明了3D打印在LAA封堵手术中的价值，但研究结果强调需要开展更大规模的多中心研究，以进一步量化其临床益处，特别是在改善手术规划和减少NVAF患者LAA血栓形成的血管内治疗并发症方面。未来的研究应侧重于多中心试验、更大的队列研究，并测试用于个性化治疗的3D打印封堵器械。
