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This study aims to develop a realistic 3D printing-based simulator for the training and planning of the left atrial appendage occlusion (LAAO) to be used in the cath lab.

Starting from a pre-operative computed tomography dataset of a patient already treated with LAAO, the model was obtained, consisting in the right and left heart, opportunely assembled to replicate the position and orientation of the patient's anatomy while lying on the cath lab table. Different 3D printing techniques and materials were used to mimic the interaction between the cardiac tissue and the clinical instrumentation. The simulator was tested in the cath lab under proper image guidance by three LAAO expert operators. The clinicians were required to assign a score in terms of realism to each material used to fabricate the fossa ovalis and the LAA.

The simulated interventions were successfully performed by the operators, who were able to navigate in the system and release the occluder device as during a real procedure. The intraoperative images acquired during the simulations were highly comparable with data from a real intervention, with a mean percentage difference below 10%.

This study demonstrated the feasibility of the proposed simulator to faithfully replicate the LAAO procedure and its potentiality to be used for multiple purposes, including the training of the young clinicians, the evaluation of the most complicated cases and the design of novel occluder devices, in a fully realistic setting.

Charles Sanders Peirce (1839–1914), recognized as the father of philosophical pragmatism, has been described as a philosopher’s philosopher. Eliyahu Moshe Goldratt (1947–2011), considered the father of the management philosophy theory of constraints (TOC), has been described as being, first and foremost, a philosopher. The TOC body of knowledge is mainly preserved as concrete methodologies used in the management discipline. By examining the foundational elements of synechism and the TOC, the purpose of this study is to investigate the intellectual connections between the arguments and legacies of Goldratt and Peirce. Although this connection is worthy of much further investigation, the research emphasizes the possible implications from a management philosophy perspective.

Based on a “review with an attitude,” the authors first examined the foundations of Goldratt’s TOC through the lens of Peirce’s synechism. Next, the authors then examined how the study of Peirce combined with a selection of contemporary research in the management and organizational studies domain could point out a direction toward completing Goldratt’s unfinished intellectual work to establish a unified science management while addressing some of the current gaps in the TOC body of knowledge.

Major findings show that synechism’s growth may extend TOC knowledge, improving managerial practice in organizations. Findings on the convergent ideas of both also reveal that Goldratt valued all synechism categories, emphasizing the importance of not overlooking Firstness. Furthermore, the study analyzes the abductive inference demonstrated in the two use cases, introducing an additional metaphor to the management of organizational systems inspired by Peirce’s philosophical concepts. The research concludes that incorporating TOC and synechism principles can enhance management and organizational practices and enrich management philosophy and theories.

This pioneering research opens promising opportunities to draw parallels between Peirce and Goldratt. Interdisciplinary collaboration will enhance the rigor and validity of integrating synechism and TOC. Experts in organizational behavior, systems theory and complexity science can provide valuable insights into this debate, while practitioners and consultants could help identify barriers and opportunities for integrating synechistic principles.

The study proposes a novel abductive approach using Peirce’s cable metaphor as an initial framework to build a unified science of management based on evolutionary stages: TOC, common sense and connectedness.

This research reinforces the argument that contemporary management practices need philosophical thinking. The authors argue that re-evaluating the foundations of management thought enriches the decision-making process in organizations and the understanding of contemporary theories in management and organizational studies.