Improved Algorithm for Ostium Size Assessment in Watchman Left Atrial Appendage Occlusion Using Three-Dimensional...

Area of Science:

• Cardiovascular Imaging
• Interventional Cardiology
• Medical Device Technology

Background:

• Accurate sizing of the left atrial appendage (LAA) ostium is critical for successful LAA occlusion procedures.
• Unfavorable LAA anatomy can complicate the precise measurement of ostium diameter using traditional methods.

Purpose of the Study:

• To evaluate the utility of area-derived diameter (ADD) and perimeter-derived diameter (PDD) from 3D-TEE.
• To compare the efficacy of 3D measurements against 2D measurements for LAA ostium sizing.

Main Methods:

• Retrospective analysis of 55 patients from the ALSTER-LAA registry.
• Correlation of 3D-TEE derived ADD and PDD with 2D measurements used for Watchman device sizing.
• Assessment of device area with 10%-30% compression and 30-day clinical outcomes.

Main Results:

• 3D measurements of LAA ostium area and perimeter aligned with calculated device size ranges.
• Instances of intraprocedural device recapture, gaps, and size changes were more frequent when ADD suggested a larger device was needed.
• 3D ADD and PDD measurements were feasible for guiding device selection.

Conclusions:

• 3D ADD and PDD are practical for LAA device sizing decisions.
• Utilizing 3D measurements may decrease intraprocedural recaptures, peridevice leakage, and device size adjustments.
• 3D-TEE offers an improved approach to LAA ostium assessment in occlusion procedures.