A systematic review of the use of 3D printing in left atrial appendage occlusion procedures

Introduction Key challenges of left atrial appendage occlusion (LAAO) procedures include accurate preprocedural device sizing and proper device positioning at the left atrial appendage (LAA) ostium to ensure sufficient device anchoring and avoid peri-device leaks. To address these challenges, 3D printing (3DP) of LAA models has recently emerged in the literature, first being described in 2015. We present a review of the benefits and drawbacks of employing this technology in LAAO procedures. Methods A comprehensive search of Pubmed was performed from database inception to October 1, 2021. A total of 19 eligible studies were identified and evaluated based on pre-, intra-, and postprocedural outcomes. Preprocediral imaging modalities, 3D segmentation software, 3D printer, 3DD printing material, occlusion deevice, cohort size, average age, thrombotic /bleeding risk scores, and AF type were also recorded when available. Results Preprocedurally the use of 3DP can consistently and accurately determine LAAO device size over the standard of care approaches. Intraprocedurally 3DP's impact entailed a statistically significant decrease in the number of devices used per procedure, as well as in the fluoroscopic time and dose. Postprocedurally, there is some evidence that 3DP could reduce the rate of peri-device leaks, with limited data on its effect on complication rates. Conclusion Based on existing evidence, we recommend the focused application of 3DP to cases of complex LAA anatomy and for the training of proceduralists. However, next-generation LAAO devices and emerging augmented/virtual reality (AR/VR) systems could limit even this narrow window of clinical benefit afforded by 3DP. of left atrial appendage include accurate preprocedural device sizing and proper device positioning at the left atrial appendage (LAA) ostium to ensure sufficient device anchoring and avoid peri-device leaks. To address these challenges, 3D printing (3DP) of LAA models has recently emerged in the literature, first being described in 2015. We present a review of the benefits and drawbacks of employing this technology in LAAO procedures.