Po-03-166 clinical feasibility of minimalist approach by 3d printed left atrial appendage (laa) model simulation for percutaneous laa closure – a multi-center case-control trial

Because of wide anatomical variations of left atrial appendage (LAA), intra-procedural verification may prolong procedure time and increase the risk of complications. In order to minimize intraprocedural steps and manipulations, non-essential steps were replaced by ex vivo pre-procedural 3D LAA model simulations – minimalist approach. We tested clinical feasibility of minimalist approach. We reviewed clinical data and procedural images of LAA occlusion cases performed in Chung-Ang University Hospital, Seoul, Korea and Yonsei University Wonju Severance Christian Hospital, Wonju, Korea. LAA occlusion cases were categorized into 2 (conventional approach and minimalist approach). Within minimalist approach, device size and actually implanted location and orientation were determined before procedure by 3D LAA model based simulation. During procedure, we tried to reduce the number of angiography, the amount of contrast agent, the number of device deployment attempt, and radiation exposure. Then, we compared outcomes between conventional approach and minimalist approach. A total of 81 patients were reviewed and analysed (conventional approach N = 53, minimalist approach N = 28, mean age: 75.2 ± 10.7 years, 42 male (51.9 %). Procedural outcomes and complications were comparable and not significantly different. By applying minimalist approach, procedure time was reduced in number (108 ± 37,6 min vs. 88.7 ± 62.1 min, P = 0.141), radiation exposure time and dosage were significantly reduced (fluoroscopic time 20.6 ± 9.8 min vs. 10.2 ± 4.8 min, P < 0.001, dose area product 131.9 ± 128.8 mGy-cm2 vs. 44.0 ± 48.3 mGy-cm2, P = 0.001). The number of device implantation attempt was significantly reduced (2.8 ± 2.1 times vs. 1.6 ± 0.9, P < 0.001), and the number of LAA angiography was significantly reduced (5.7 ± 4.7 vs. 2.0 ± 1.3 times, P < 0.001), and the amount of contrast agent was significantly reduced (296.5 ± 155.8 ml vs. 150.9 ± 73.2 ml, P = 0.002). By applying minimalist approach, LAA occlusion procedure became shorter, safer and similarly effective without any trade-offs. Therefore, minimalist approach was feasible approach and further study is required.