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Catheter-based left atrial appendage closure
Hozman, Marek ; Osmančík, Pavel (advisor) ; Bulava, Alan (referee) ; Havránek, Štěpán (referee)
Transseptal puncture in left atrial appendage closure guided by 3D printing and multiplanar CT reconstruction Abstract Introduction: The presented study investigates the application of bi-atrial 3D printed models to guide transseptal puncture (TSP) in left atrial appendage occlusion (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. Methods: Pre-procedural planning included multiplanar CT reconstruction, 3D segmentation, and 3DP. TSP was pre-procedurally simulated in vitro at six defined sites. Based on the position of the sheath, TSP sites were classified as optimal, sub-optimal, or non-optimal. The aim was to target the TSP in the recommended position during the procedure. Procedure progress was assessed post hoc by the operator. Results: Of 68 screened patients, 60 patients in five centres (mean age of 74.68 ± 7.64 years, 71.66% males) were prospectively analysed (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...
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