Three-Dimensional-Printed Models Reduce Adverse Events of Left Atrial Appendage Occlusion: A Systematic Review and Meta-Analysis.

Background and aims: Left atrial appendage occlusion (LAAO) has an excellent safety profile but there is growing evidence of adverse long-term sequelae of peri-device leak and device-related thrombus. This study seeks to determine if guidance from 3D-printed models of left atrial appendages reduces the incidence of side effects.

Methods: A systematic literature search was conducted in the following databases: Pubmed, Google Scholar, and Europe PMC. Cohort studies that directly compared outcomes using 3D-printed model simulations before undergoing LAAO versus using conventional imaging only among patients with nonvalvular atrial fibrillation, CHA₂DS₂-VASc scores ≥ 1, and relative or absolute contraindications to long-term anticoagulation were included. Clinical outcomes included incidence of peri-device leak, mismatch, and device-related thrombus. Meta-analysis was done using the random-effects model.

Results: Only three cohort studies were eligible for meta-analysis with a mean follow-up period of 25 months. This included a total of 204 patients (mean age, 75 years). Using 3D printed models of left atrial appendage based on transesophageal echocardiogram and cardiac computed tomography had statistically significantly less incidence of peri-device leak (log OR -2.47; 95% CI: -3.70 to 1.24; p = 0.00), incidence of mismatch (log OR -1.61; 95% CI: -2.50 to 0.73; p = 0.00) and shorter procedural time (mean difference -24.86; 95% CI: -31.75 and -27.11; p = 0.00). Although the incidence of device-related thromboembolism was 49% less in the 3D printing-guided group, the difference was not statistically significant (p = 0.58).

Conclusion: Less incidence of peri-device leak and mismatch were observed with 3D printing-guided left atrial appendage occlusion. A highly powered randomized controlled trial may have to be done to confirm the findings.