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International Journal of Bioprinting Evaluation of advanced visual computing solutions for the left atrial appendage occlusion

Figure 7 also illustrates the extremes in physician
approaches toward the use of these technologies, with
one of them (P3) not willing to add any of them into the
clinical workflow, and the counterpart one (P6) opting for P6 (I) Web/VR/3Dpr/ Sim A22/A22/A22/A22 A18/A18/A18/A18 A20/A18/A18/A18 W20/A18/A18/A18 W24/W20/W20/W20
incorporating all of them. We would like to point out that
P6 was the physician with more previous experience and
interest on computational tools. An important remark
from P6 was that a single software integrating the access to
all different technologies is necessary.
3.4. Device selection comparison
Table 3 illustrates the interparticipant variation in LAAO P5 (I) Web/VR/3Dpr/ Sim A25/A28/A20/A28 A20/A22/A16/A22 A18/A18/A18/A18 A20/A22/A18/A22 A25/A25/A20/A25
device selection after testing each computing technology,
where different patterns can be observed. For instance,
participants P1 and P5 (both imaging specialists) tended to
select smaller devices with 3D printing, which they attributed
to the rigidity of LA walls in the printed model. Therefore,
they mainly used other technologies for their final LAAO
device decision. Participants P2 and P4 (both interventional
cardiologists) also followed the same pattern, without P4 (IC) Web/VR/3Dpr/ Sim A25/A22/A22/A22 A20/A16/A16/A16 A18/A18/A18/A18 A20/A18/A18/A18 A25/A25/A25/A25
much LAAO size variation between different technologies.
However, they were inclined to select a larger device in the
VIDAA platform since it is not obvious to check for potential
leaks in it, thus overestimating the size. On the other hand,
features in the VRIDAA platform (e.g., being within the
LA cavity) and in silico simulations (e.g., functional flow Web: Web-based VIDAA platform; VR: Virtual reality VRIDAA platform; 3Dpr: 3D printing; Sim: Fluid simulations; W: Watchman flex; A: Amplatzer Amulet. Numbers refer to the device size (in
information) made these two technologies better suited P3 (IC) Web/ VR/3Dpr/Sim A28/A22/A20/A22 A22/A22/A20/A22 A22/A22/A20/A22 A22/A22/A20/A20 A28/A28/A25/A25
for a more optimal device position to avoid leaks. Finally,
participant P6 rarely changed the selected device after
testing each technology.
In three of the studied cases (C2, C3, and C4), there
were substantial intraparticipant variations (e.g., more
than 2 device sizes), while in the remaining cases, final
decisions were quite similar. The main reason for these
variations was the different LAA morphologies of the P2 (IC) Web/VR/3Dpr/ Sim W24/W24/A25/A22 A22/A18/W20/A18 W24/A22/W20/A22 W27/W27/W20/W24 A28/A25/A22/A25
two groups of cases; the first group had a so-called
chicken wing-type morphology that allows a different Table 3. Devices selected by the participants (P1 – P6) after using each computing technology
interventional technique (e.g., sandwich) with larger
LAAO device sizes, which is preferred by some
physicians. Unfortunately, the sandwich technique was mm). In bold, when the device settings coincide with the final decision made by the clinician
not considered in any of the studied technologies. On
the other hand, the agreement in the non-CW LAA cases
(i.e., C1 and C5) was higher, as can be seen in Table 3.
Shockingly, none of the participants proposed the LAAO P1 (I) Web/VR/3Dpr/ Sim A25/A22/A16/A22 A20/A18/A16/A16 A22/A20/A16/A18 A20/A20/A18/A18 A25/A25/A18/A22
device, which was finally implanted in case C4.

Table 4 shows the final LAAO devices selected for each
participant in all studied cases, compared to the device
effectively implanted in the patient. Most LAAO devices
selected by participants were the Amplatzer Amulet since
it was the device mainly used in their training period and Case no.
they had more experience with it. Therefore, they felt more C1 C2 C3 C4 C5

Volume 9 Issue 1 (2023) 268 https://doi.org/10.18063/ijb.v9i1.640