Is pre-procedural CT TruPlan-based reasonably enough?
The authors have performed LAAO by using ICE to guide transseptal puncture and view the LAA from the left atrium. The use of ICE favors a smoother intraprocedural workflow, since general anesthesia is not required and the operator can easily maneuver the ICE probe with no need of the echo expert’s assistance. In our own experience, LAA visualization and measurements, ruling out thrombus, device sizing and placement can effectively achieved through ICE and with an excellent outcome (9). Also, with the advent of 3-D ICE technology (10), more reliable and adequate measurements is offered guiding to a successful and safe LAAO procedure . Unfortunately, in this prospective study there is no data comparing the pre-procedural CT information obtained through the TruPlan software with that produced by intraprocedural ICE. The demonstration that device selection provided by pre-procedural CT-scan TruPlan software based consistently coincides with the device sizing obtained by intraprocedural ICE measurements, would have reinforced the significance of this novel pre-procedural CT methodology. Furthermore, no direct comparison was made in randomizing fashion with other CT-scan sizing methodologies.