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

techniques into the industrial training programs would images could also be used in the presented visual computing
help further standardize LAAO implantation procedures. solutions, mainly with advanced 3D rendering or in VR
Effectively, physicians highlighted the potential role of 3D setups [11,24] , but anatomical details of the structures under
printing and the VR VRIDAA platform for training clinical study will be lost, which could negatively affect the medical
fellows, especially on challenging cases. A complementary decisions on the devices to implant. Otherwise, the manual
and very important use of these technologies according to steps and time required for creating the 3D models from
domain experts involves patient education, which could the original medical images could be a limitation for the
contribute to reduce the levels of stress and anxiety before clinical translation of the evaluated tools. Nevertheless,
the intervention thanks to a better understanding of the the use of automatic deep learning techniques for LA
procedure. A final comment was related to the application segmentation and mesh creation is being developed and
of the assessed computing solutions to other structural should be available soon. Furthermore, it would have
heart disease procedures involving medical devices such been useful to include new photorealism and advanced
[11]
as transaortic valvular interventions since the technologies cinematic rendering visualization in our study, which
would only need slight modifications from the current will be planned in the future. In addition, other anatomical
LAAO-based use case. structures, relevant for the LAAO procedure, such as the
There are some limitations in our study. First, only fossa ovalis for guiding catheters into the LA, should be
a small cohort consisting of six participants was able incorporated in different computing technologies for a
to evaluate the computing technologies. Moreover, all more complete planning of the intervention. Finally, an
participants were trained with a single LAAO device evaluation study where the advanced visual computing
(Amplatzer Amulet), thus undoubtedly creating some bias solutions are implemented and tested in the hospital
favoring such a device. Furthermore, the disagreements would complete the current work, where the technologies
found between the final selected and the implanted devices were tested by domain experts in a research laboratory.
may be misleading since follow-up information was not 5. Conclusions
available for the analyzed cases; therefore, the implanted
device could not be ideal, eventually leading to abnormal In this work, we evaluated several computing technologies to
events at some point. assess their added value, limitations, and requirements before
they are translated to a clinical environment, particularly
Another possible factor that could impact the evaluation for the planning of left atrial appendage occlude (LAAO)
of the technologies is that the same five cases were analyzed interventions. All the evaluated technologies could be
by the users, following the same order, which could lead beneficial in different steps of the LAAO clinical workflow,
to a model learning effect: Participants remembered their even if most need some adaptation to fit in the hospital
choices with previously tested technologies, making their routine. Specifically, the web-based 3D imaging VIDAA
analysis not fully independent. The rationale of the chosen platform provided a complete morphological characterization
order was going from the most clinically available to the and excellent user interaction to manipulate and test multiple
most sophisticated technologies, but a more randomized device configurations. Economical 3D-printed models,
study that includes more cases should be performed in the although lacking completely realistic device-LAA interaction,
future to alleviate the learning effect. Using computational were useful to have a better perception of the 3D LAA anatomy
tools that all had been developed by the authors provided an and can be easily integrated in the current clinical workflows.
unbiased analysis toward the preferred technology or which VR technologies, which are especially suited for educational
one should be considered the best. On the other hand, or pre-operative planning purposes, were also very helpful
the maturity of the individual instance of each technology for 3D perception, but only simple VR headsets would be
certainly had an influence on the evaluation results, not suitable for daily clinical routine. In silico fluid simulations
necessarily reflecting the technology potential. For instance, with LAAO devices have potential to reduce the risk of leaks
in silico fluid simulations could obtain better scores with a and device-related thrombus after the implantation but
more mature user interface while 3D printing would be better required more user-friendly interfaces. In consequence, all the
assessed with more realistic, soft, and elastic materials . evaluated computing technologies could contribute to better
[43]
However, the present study successfully identified the most personalization of LAA intervention and post-interventional
relevant aspects to consider in each technology for clinical treatment to each patient, which helps ensure better outcomes.
translation, beyond individual instances. Advanced versions of the studied computing solutions will
In addition, we evaluated all computing technologies be properly embedded in clinical workflows soon, especially
on 3D models built from CT medical images, which are not if they can be all integrated into a single space or software
always available for LAAO planning. Echocardiography platform, as most participants of this study demanded.

Volume 9 Issue 1 (2023) 271 https://doi.org/10.18063/ijb.v9i1.640