Adil Rajwani1,2, Adam J Nelson2,3, Masoumeh G Shirazi2,3, Patrick J S Disney2, Karen S L Teo2,3, Dennis T L Wong4, Glenn D Young2,3, Stephen G Worthley2,3. 1. Department of Cardiology, Royal Perth Hospital, 197 Wellington Street, Perth, WA 6000, Australia. 2. Department of Cardiology, Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000, Australia. 3. Discipline of Medicine, University of Adelaide, Adelaide, SA 5000, Australia. 4. MonashHeart and Department of Medicine, Monash University, Melbourne, VIC 3168, Australia.
Abstract
AIMS: We evaluated the utility of computerized tomography (CT) with respect to sizing work-up for percutaneous left atrial appendage (LAA) closure, and implications for procedural safety and outcomes. METHODS AND RESULTS: Contrast-enhanced multi-detector CT was routinely conducted to guide sizing for LAA closure in addition to transoesophageal echocardiography (TOE). Procedural safety and efficacy were prospectively assessed. Across 73 consecutive cases there were no device-related procedural complications, and no severe leaks. Systematic bias in orifice sizing by TOE vs. CT was significant on retrospective analysis (bias -3.0 mm vs. maximum diameter on CT; bias -1.1 mm vs. mean diameter on CT). Importantly, this translated to an altered device size selection in more than half of all cases, and median size predicted by CT was one interval greater than that predicted by TOE (27 mm vs. 24 mm). Of particular note, gross sizing error by TOE vs. CT was observed in at least 3.4% of cases. Degree of discrepancy between TOE and CT was correlated with LAA orifice eccentricity, orifice size, and left atrial volume. Mean orifice size by CT had the greatest utility for final Watchman device-size selection. CONCLUSIONS: In this single-centre registry of LAA closure, routine incorporation of CT was associated with excellent outcomes for procedural safety and absence of major residual leak. Mean orifice size may be preferable to maximum orifice size. A particular value of CT may be the detection and subsequent avoidance of gross sizing error by 2D TOE that occurs in a small but important proportion of cases. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: We evaluated the utility of computerized tomography (CT) with respect to sizing work-up for percutaneous left atrial appendage (LAA) closure, and implications for procedural safety and outcomes. METHODS AND RESULTS: Contrast-enhanced multi-detector CT was routinely conducted to guide sizing for LAA closure in addition to transoesophageal echocardiography (TOE). Procedural safety and efficacy were prospectively assessed. Across 73 consecutive cases there were no device-related procedural complications, and no severe leaks. Systematic bias in orifice sizing by TOE vs. CT was significant on retrospective analysis (bias -3.0 mm vs. maximum diameter on CT; bias -1.1 mm vs. mean diameter on CT). Importantly, this translated to an altered device size selection in more than half of all cases, and median size predicted by CT was one interval greater than that predicted by TOE (27 mm vs. 24 mm). Of particular note, gross sizing error by TOE vs. CT was observed in at least 3.4% of cases. Degree of discrepancy between TOE and CT was correlated with LAA orifice eccentricity, orifice size, and left atrial volume. Mean orifice size by CT had the greatest utility for final Watchman device-size selection. CONCLUSIONS: In this single-centre registry of LAA closure, routine incorporation of CT was associated with excellent outcomes for procedural safety and absence of major residual leak. Mean orifice size may be preferable to maximum orifice size. A particular value of CT may be the detection and subsequent avoidance of gross sizing error by 2D TOE that occurs in a small but important proportion of cases. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Andrew Schluchter; Chelsea Jan; Katherine Lowe; Davis M Vigneault; Francisco Contijoch; Elliot R McVeigh Journal: Circ Cardiovasc Imaging Date: 2019-12-17 Impact factor: 7.792
Authors: Matthew D Grant; Ryan D Mann; Scott D Kristenson; Richard M Buck; Juan D Mendoza; Jason M Reese; David W Grant; Eric A Roberge Journal: Radiographics Date: 2021-06-11 Impact factor: 6.312