Prospective, randomized comparison of 3-dimensional computed tomography guidance versus tee data for left atrial appendage occlusion
Eng M, Dee Wang D, Greenbaum A, Gheewala N, Aka T, Song T, Pantelic M, Keimig T, Hawasli H, Kendall B, Wyman J, Myers E, O'Neill W. Prospective, randomized comparison of 3-dimensional computed tomography guidance versus tee data for left atrial appendage occlusion (pro3dlaao). J Am Coll Cardiol. 2017;70(18):B216.
J Am Coll Cardiol
BACKGROUND Preliminary data comparing 3-dimensionalcomputed tomography (3D-CT) to transesophageal echocardiography (TEE) for left atrial appendage occlusion(LAAO) indicates that 3D-CT provides more accurate measurements and improves case planning. Therefore, we conducted a pilot study comparing 3D-CT to TEE in occluder selection accuracy and procedural efficiency. METHODS From May 2016 to February 2017, 24 patients were prospectively randomized to undergo LAAO using either TEE or 3D-CT. The primary endpoint was device accuracy while the secondary endpoints included # devices per case, # guide catheters used per case, # fluoroscopy angles used, procedure time, fluoroscopy time, radiation dose and major adverse events (stroke, MI, device embolization, perforation, death). RESULTS Procedure success was 100% and 92% forthe 3D-CT and 2DTEE cohorts respectively. Accuracy for 1st device selection 92% and 25% for 3D-CT and 2D-TEErespectively but with intra-procedural upsizing in the 2D-TEE cohort, the 2D-TEE cohort accuracy increased to 64% while the 3D-CT groups 92% was accurate (p=0.33). Case planning using 3D-CT was significantly more efficient with respect to device utilization (CT 1.33±0.7 vs. 2D-TEE 2.5±1.2 p=0.01), guide catheters (CT 1 vs. 2D-TEE 1.7±0.8 p=0.01) and procedure time (3D-CT 55±17 min. vs. 2D-TEE 73±24 min. p<0.05). One major adverse event, a stroke occurred in the 2D-TEE group. CONCLUSION CT guided LAAO case planning is superior to 2D-TEE with respect to device selection accuracy and procedural efficiency. This study proves that comprehensive 3D assessment significantly simplifies LAAO, minimizing the time and number of steps needed for procedure success (Figure Presented).