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3D printing for left atrial appendage closure: a meta-analysis of cohort studies
Session:
Comunicações Orais (Sessão 9) - Intervenção Cardíaca Coronária e Estrutural 2 - Vários Tópicos
Speaker:
Diana De Campos
Congress:
CPC 2022
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.4 Interventional Cardiology - Other
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Diana Decampos; Rogério Teixeira; Carolina Saleiro; Manuel Oliveira-Santos; Luis Paiva; Marco Costa; Ana Botelho; Lino Gonçalves
Abstract
<p>The most recent data on peridevice leaks (PDL) show that moderate to severe PDL are present at 12 months in 10% - 27.5% of patients following left atrial appendage closure (LAAC). Accurately sizing the occluder device is pivotal in LAAC to avoid PDL and procedural complications. Three dimension printing (3DP) has emerged as an alternative to imaging to guide LAAC device sizing. We assessed the usefulness of a 3DP based compared to a standard only-imaging approach for LAAC. A fixed-effects meta-analysis was performed targeting a co-primary endpoint of disagreement in device sizing and PDL. The quality of individual studies was assessed using the Newcastle-Ottawa scale. Subgroup analyses were performed to explore possible sources of heterogeneity. Eight studies met our inclusion criteria with a total of 307 patients (144 underwent 3DP). Mean ages ranged from 69 to 79 years. Baseline mean CHA2DS2-VASc and HAS-BLED scores ranged from 3.0 to 4.9 and 3.1 to 4.8 points, respectively. Stroke or transient ischemic accident and previous bleeding were prevalent conditions. The Amplatzer device was used in two studies and the Watchman device was the choice in the remaining series. Overall, 84 patients had a disagreement in device sizing and/or a PDL. 3DP significantly reduced the risk of the co-primary endpoint (RR = 0.19; 95% CI 0.09-0.37) with consistency across the studies (I2=0%). Individually, both size disagreements and leaks were reduced under a 3DP modeling strategy compared to an imaging-only strategy. Sensitivity analysis showed that the magnitude of the pooled estimates did not significantly change under a fixed-effects model. This meta-analysis of cohort studies shows that 3DP disagreement in device sizing and PDL when compared to an imaging-only approach. Larger randomized controlled trials with an imaging core laboratory are needed. Nevertheless, our analysis identified key experimental features required for future studies.</p> <p>Legend of figure 1: (A) Fixed-effects model comparing the composite endpoint of disagreement in landing zone size estimation and peridevice leaks between procedures guided by 3D printing and procedures guided by imaging only. (B) Fixed-effects model comparing over and underestimation of the LAA occluder between 3D printing model and imaging. (C) Fixed-effects model comparing post-procedural peridevice leaks between 3D printing model and imaging.</p>
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