An anthropomorphic phantom for atrial transseptal puncture simulation training

TY - JOUR

T1 - An anthropomorphic phantom for atrial transseptal puncture simulation training

AU - Zeidan, Aya Mutaz

AU - Xu, Zhouyang

AU - Leung, Lisa

AU - Byrne, Calum

AU - Sabu, Sachin

AU - Zhou, Yijia

AU - Rinaldi, Christopher Aldo

AU - Whitaker, John

AU - Williams, Steven E

AU - Behar, Jonathan

AU - Arujuna, Aruna

AU - Housden, R James

AU - Rhode, Kawal

N1 - Publisher Copyright: © The Author(s) 2024.

PY - 2024/10/30

Y1 - 2024/10/30

N2 - BACKGROUND: Transseptal puncture (TSP) is a critical prerequisite for left-sided cardiac interventions, such as atrial fibrillation (AF) ablation and left atrial appendage closure. Despite its routine nature, TSP can be technically demanding and carries a risk of complications. This study presents a novel, patient-specific, anthropomorphic phantom for TSP simulation training that can be used with X-ray fluoroscopy and ultrasound imaging.METHODS: The TSP phantom was developed using additive manufacturing techniques and features a replaceable fossa ovalis (FO) component to allow for multiple punctures without replacing the entire model. Four cardiologists and one cardiology trainee performed TSP on the simulator, and their performance was assessed using four metrics: global isotropy index, distance from the centroid, time taken to perform TSP, and a set of 5-point Likert scale questions to evaluate the clinicians' perception of the phantom's realism and utility.RESULTS: The results demonstrate the simulator's potential as a training tool for interventional cardiology, providing a realistic and controllable environment for clinicians to refine their TSP skills. Experienced cardiologists tended to cluster their puncture points closer to regions of the FO associated with higher global isotropy index scores, indicating a relationship between experience and optimal puncture localization. The questionnaire analysis revealed that participants generally agreed on the phantom's realistic anatomical representation and ability to accurately visualize the TSP site under fluoroscopic guidance.CONCLUSIONS: The TSP simulator can be incorporated into training programs, offering trainees the opportunity to improve tool handling, spatial coordination, and manual dexterity prior to performing the procedure on patients. Further studies with larger sample sizes and longitudinal assessments are needed to establish the simulator's impact on TSP performance and patient outcomes.

AB - BACKGROUND: Transseptal puncture (TSP) is a critical prerequisite for left-sided cardiac interventions, such as atrial fibrillation (AF) ablation and left atrial appendage closure. Despite its routine nature, TSP can be technically demanding and carries a risk of complications. This study presents a novel, patient-specific, anthropomorphic phantom for TSP simulation training that can be used with X-ray fluoroscopy and ultrasound imaging.METHODS: The TSP phantom was developed using additive manufacturing techniques and features a replaceable fossa ovalis (FO) component to allow for multiple punctures without replacing the entire model. Four cardiologists and one cardiology trainee performed TSP on the simulator, and their performance was assessed using four metrics: global isotropy index, distance from the centroid, time taken to perform TSP, and a set of 5-point Likert scale questions to evaluate the clinicians' perception of the phantom's realism and utility.RESULTS: The results demonstrate the simulator's potential as a training tool for interventional cardiology, providing a realistic and controllable environment for clinicians to refine their TSP skills. Experienced cardiologists tended to cluster their puncture points closer to regions of the FO associated with higher global isotropy index scores, indicating a relationship between experience and optimal puncture localization. The questionnaire analysis revealed that participants generally agreed on the phantom's realistic anatomical representation and ability to accurately visualize the TSP site under fluoroscopic guidance.CONCLUSIONS: The TSP simulator can be incorporated into training programs, offering trainees the opportunity to improve tool handling, spatial coordination, and manual dexterity prior to performing the procedure on patients. Further studies with larger sample sizes and longitudinal assessments are needed to establish the simulator's impact on TSP performance and patient outcomes.

UR - https://www.scopus.com/pages/publications/85208436928

U2 - 10.1186/s41205-024-00241-y

DO - 10.1186/s41205-024-00241-y

M3 - Article

C2 - 39472399

SN - 2365-6271

VL - 10

JO - 3D printing in medicine

JF - 3D printing in medicine

IS - 1

M1 - 34

ER -