Novel integrated 3D multidetector computed tomography and fluoroscopy fusion for left atrial appendage occlusion procedures

Roy, Andrew K.; Horvilleur, J.; Cormier, Bertrand; Cazalas, Maxime; Fernández, Leticia; Patané, Martina; Spaziano, Marco; Sawaya, Fadi J.; Arai, T.; Bouvier, Erik; Hovasse, Thomas; Lefèvre, Thierry; Chevalier, Bernard; Garot, Philippe

doi:10.1002/ccd.26998

Cited by 17 publications

(20 citation statements)

References 20 publications

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“…erefore, it is reasonable that centers with greater LAAC volume and experience should explore different options to expand LAAC availability. LAAC procedures performed without general anesthesia have been published, either with micro-TOE imaging under conscious sedation or other imaging modalities [3][4][5].…”

Section: Discussionmentioning

confidence: 99%

“…Nonetheless, it is generally assumed that general anesthesia is also one of the most limiting factors for LAAC availability as it requires the presence of an anesthesiologist. In an attempt to avoid the need for general anesthesia and to facilitate the performance of LAAC, other procedural approaches such as micro-TOE probe with conscious sedation [3], intracardiac echo [4], and even 3D computed tomography fusion images [5] have been described. Although feasible for LAAC guidance, these methods have limitations.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of Different Procedural Approaches for Left Atrial Appendage Closure: Searching for Simplicity

Ruíz-Salmerón

Robles-Pérez

Ronquillo-Japón

et al. 2021

Journal of Interventional Cardiology

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Aim. To assess procedural and long-term efficacy and safety of two alternative methods for appendage closure, conscious sedation with standard transoesophageal echo and procedure guided by rotational angiography. Background. Demand for appendage closure is increasing, and a reasonable time-response should be given to nonvalvular atrial fibrillation patients not suitable to receive anticoagulation. General anesthesia and the need for an anesthesiologist are limiting factors to improve procedure availability; it is time to introduce simpler approaches. Methods. Single center experience in appendage closure during 9 years, using three different procedural approaches: general anesthesia with echo guidance, conscious sedation with echo guidance, and rotational angiography guidance. Conscious sedation and rotational angiography-guided procedures were performed in the absence of an anesthesiologist. Procedural characteristics and follow-up events were recorded. Results. 260 consecutive appendage closure procedures were reviewed: 155 were performed under general anesthesia (59.6%), 71 were performed with conscious sedation (27.3%), and 34 were rotational angiography guided (13.1%). Device success rate for procedures guided by rotational angiography was significantly lower than that for general anesthesia and conscious sedation (91.2% versus 100% versus 98.6%, p = 0.001 ) because there was a greater need to recapture and change device size. However, final procedural success was high and without difference between approaches (98.8% versus 97.2% versus 100%, for general anesthesia, conscious sedation, and rotational angiography, respectively); with a median follow-up of 17 months (CI 95% 13–23 month) (637.9 patients-year), there was no difference among approaches for thromboembolic (1.3 versus 1.8 versus 1.8) and major bleeding events (3.2 versus 2.8 versus 1.8), respectively. Conclusions. Appendage closure performed, either with conscious sedation with echo guidance or rotational angiography guided, is feasible, with no difference in procedural success and follow-up events compared with general anesthesia and without the limitation of the need for an anesthesiologist on-site.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparison of Different Procedural Approaches for Left Atrial Appendage Closure: Searching for Simplicity

Ruíz-Salmerón

Robles-Pérez

Ronquillo-Japón

et al. 2021

Journal of Interventional Cardiology

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“…Cardiac CT can be co‐registered to intraprocedural fluoroscopy to guide percutaneous mitral valve repair and perivalvular leak closure 4 . CT and fluoroscopic fusion imaging have also been applied to LAA occlusion 5 . Intraprocedural TEE and fluoroscopy can also be fused to allow 3D visualization of cardiac anatomy for a number of different procedures including perivalvular leak closure, MitraClip (Abbott Laboratories), and Cardioband (Edwards Lifesciences) 6 .…”

Section: Discussionmentioning

confidence: 99%

Novel use of fused cardiac computed tomography and transesophageal echocardiography for left atrial appendage closure

Peters

Motiwala

O’Neill

et al. 2020

Cathet Cardio Intervent

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The use of the Watchman left atrial appendage occlusion device (Boston Scientific Inc.) is becoming increasingly frequent in patients with atrial fibrillation. Cardiac computed tomography (CT) for device sizing pre‐procedure can help facilitate more accurate device selection compared with transesophageal echo (TEE) alone. CT can also help identify minor lobes and trabeculations that may not be apparent on TEE. We report a series of three cases to highlight the utility of a novel application of CT‐TEE fusion imaging to provide procedural guidance during Watchman implant and to assess for peri‐device leak post‐implant.

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“…It is difficult to gauge intricate anatomy from the 2D fluoroscopic silhouette. 3D-CT registration on fluoroscopy during Watchman LAAC has been demonstrated to tackle this constraint [11]. Similarly, we referred to 3D-CT images during fluoroscopy, but while utilizing personalized viewing angles concurrently.…”

Section: Fluoroscopy In Watchman Implantationmentioning

confidence: 99%

Personalized Fluoroscopic Angles in Watchman™ Left Atrial Appendage Closure Landing Zone Assessment: A Three-Dimensional Printed Simulation Study

Shee

Liu

et al. 2020

Cureus

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Background Atrial fibrillation causes ischemic stroke when thrombi dislodge from a cardiac outpouching, the left atrial appendage (LAA), and embolize to the brain. LAA occlusion with the Watchman™ device (Boston Scientific Corporation, MA, USA), which prevents stroke, requires accurate LAA measurements for device sizing. We explore whether standard fluoroscopic LAA measurements improve when obtained at CT-derived viewing angles personalized to LAA anatomy while concurrently referring to three-dimensional (3D) CT. Methods Left atrial 3D reconstructions created from contrast CT (n=28) were analysed to identify personalized viewing angles wherein LAA dimensions (LAA maximum landing zone diameter and LAA length) were best observed. The 3D-CT reconstructions were then 3D printed with stands. Fluoroscopy of anatomically oriented models in the catheter lab simulated LAA angiography. Fluoroscopic images were acquired at standard (caudal 20˚/right anterior oblique 30˚) and personalized viewing angles. Repeated measurements of LAA dimensions were taken from CT (Control), fluoroscopy at standard angles (Standard), personalized angles (Blinded), and personalized angles while concurrently referring to 3D CT (Referred). Results Control measurements correlated and agreed better with Referred and Blinded measurements than with Standard measurements (diameter correlation and agreement: Control/Standard r=.554, limits of agreement [LOAs]=6.

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Novel integrated 3D multidetector computed tomography and fluoroscopy fusion for left atrial appendage occlusion procedures

Abstract: The addition of this novel fusion technology is safe and feasible. To optimize LAA procedural success, fusion integration may offer a promising addition, or alternative, to current imaging modalities. © 2017 Wiley Periodicals, Inc.

Cited by 17 publications

References 20 publications

Comparison of Different Procedural Approaches for Left Atrial Appendage Closure: Searching for Simplicity

Comparison of Different Procedural Approaches for Left Atrial Appendage Closure: Searching for Simplicity

Novel use of fused cardiac computed tomography and transesophageal echocardiography for left atrial appendage closure

Personalized Fluoroscopic Angles in Watchman™ Left Atrial Appendage Closure Landing Zone Assessment: A Three-Dimensional Printed Simulation Study

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