CT based 3D printing is superior to transesophageal echocardiography for pre-procedure planning in left atrial appendage device closure

Accurate assessment of the left atrial appendage (LAA) is important for pre-procedure planning when utilizing device closure for stroke reduction. Sizing is traditionally done with transesophageal echocardiography (TEE) but this is not always precise. Three-dimensional (3D) printing of the LAA may be more accurate. 24 patients underwent Watchman device (WD) implantation (71?±?11 years, 42% female). All had complete 2-dimensional TEE. Fourteen also had cardiac computed tomography (CCT) with 3D printing to produce a latex model of the LAA for pre-procedure planning. Device implantation was unsuccessful in 2 cases (one with and one without a 3D model). The model correlated perfectly with implanted device size (R²?=?1; p?2?=?0.34; 95% CI 0.23–0.98, p?=?0.03). Fisher’s exact test showed the model better predicted final WD size than TEE (100 vs. 60%, p?=?0.02). Use of the model was associated with reduced procedure time (70?±?20 vs. 107?±?53 min, p?=?0.03), anesthesia time (134?±?31 vs. 182?±?61 min, p?=?0.03), and fluoroscopy time (11?±?4 vs. 20?±?13 min, p?=?0.02). Absence of peri-device leak was also more likely when the model was used (92 vs. 56%, p?=?0.04). There were trends towards reduced trans-septal puncture to catheter removal time (50?±?20 vs. 73?±?36 min, p?=?0.07), number of device deployments (1.3?±?0.5 vs. 2.0?±?1.2, p?=?0.08), and number of devices used (1.3?±?0.5 vs. 1.9?±?0.9, p?=?0.07). Patient specific models of the LAA improve precision in closure device sizing. Use of the printed model allowed rapid and intuitive location of the best landing zone for the device.