Application of 3-Dimensional Computed Tomographic Image Guidance to WATCHMAN Implantation and Impact on Early Operator Learning Curve: Single-Center Experience
Wang DD, Eng M, Kupsky D, Myers E, Forbes M, Rahman M, Zaidan M, Parikh S, Wyman J, Pantelic M, Song T, Nadig J, Karabon P, Greenbaum A, O'Neill W. Application of 3-dimensional computed tomographic image guidance to WATCHMAN implantation and impact on early operator learning curve: Single-center experience. JACC Cardiovasc Interv. Nov 28 2016;9(22):2329-2340.
JACC Cardiovasc Interv
OBJECTIVES: The aim of this study was to examine the impact of 3-dimensional (3D) computed tomographic (CT) guided procedural planning for left atrial appendage (LAA) occlusion on the early operator WATCHMAN learning curve.
BACKGROUND: Traditional WATCHMAN implantation is dependent on 2-dimensional transesophageal echocardiographic (TEE) sizing and intraprocedural guidance.
METHODS: LAA occlusion with the WATCHMAN device was performed in 53 patients. Pre-procedural case plans were generated from CT studies with recommended device size, catheter selection, and C-arm angle for deployment.
RESULTS: All 53 patients underwent successful LAA occlusion with the WATCHMAN. Three-dimensional CT LAA maximal-width sizing was 2.7 ± 2.2 mm and 2.3 ± 3.0 mm larger than 2-dimensional and 3D TEE measurements, respectively (p ≤ 0.0001). By CT imaging, device selection was 100% accurate. There were 4 peri-WATCHMAN leaks (
CONCLUSIONS: Three-dimensional CT image case planning provides a comprehensive and customized patient-specific LAA assessment that appears to be accurate and may possibly facilitate reducing the early WATCHMAN implantation learning curve.
Medical Subject Headings
Aged; Aged, 80 and over; Anatomic Landmarks; Atrial Appendage; Cardiac Catheterization; Clinical Competence; Echocardiography, Three-Dimensional; Echocardiography, Transesophageal; Female; Humans; Imaging, Three-Dimensional; Learning Curve; Male; Michigan; Predictive Value of Tests; Prosthesis Design; Radiographic Image Interpretation, Computer-Assisted; Reproducibility of Results; Septal Occluder Device; Therapy, Computer-Assisted; Tomography, X-Ray Computed; Treatment Outcome