There is no agreement among some of the top structural heart experts who perform left atrial appendage occlusion (LAAO) if cardiac computed tomography (CT) is necessary to plan the procedure. Some experts at the 2022 Transcatheter Valve Therapies (TVT) Structural Heart Summit said in LAA sessions they used transesophageal echo (TEE), others use intracardiac echo (ICE) and others prefer CT. While there were several benefits to CT pointed out in sessions, reservations remained with some because of the cost and lack of reimbursement.
Recent findings from a Henry Ford Hospital Center for Structural Heart Disease study published in the Journal of the American Heart Association showed CT use was associated with higher successful device implantation rates, shorter procedural times, and less frequent changes in device sizes. This study looked at the use of the self-expanding Watchman device during a catheter-based, minimally invasive procedure. Once implanted, the device permanently seals off that heart muscle pocket, which is the source of most stroke-causing clots in AFib patients.
Transcatheter LAA occlusion can reduce the risk of blood clots that can lead to stroke and eliminate the need to take anticoagulants for patients with non-valvular atrial fibrillation (AFib). However, the LAA comes in a variety of shapes, sizes and depths so it is important to image the LAA and properly size the device needed and to ensure it will fit in the LAA and not embolize.
“The standard method for imaging the heart to guide LAAO procedures is 2D TEE. This study aimed to assess the value of adding three dimensional CT imaging to that process, versus using only TEE imaging,” explained Dee Dee Wang, MD, director of structural heart imaging at Henry Ford Hospital and the study’s senior author, in a statement. “Our findings indicate significant benefit by adding CT imaging, which uses X-ray to help create a more comprehensive 3D image of the heart.”
The hospital has been a pioneer in using advanced CT for structural heart procedure imaging, including transcatheter aortic valve replacement (TAVR), mitral valve repair and replacement (TMVR) and tricuspid valve repair and replacement (TTVR).
“CT imaging allows us to take all the guesswork out of device implantation. We know that we can safely close the appendage and have a success rate of 98% when imaging is available,” said William O’Neill, MD, director of the Henry Ford Center for Structural Disease in the statement.