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LAA closure device

Xianfeng Du, Huimin Chu, Ping Ye, Bin He, Huaiqin Xu, Shubin Jiang, Miao Lin, Rong Lin, Jing Liu, Binhao Wang, Mingjun Feng, Yibo Yu, Xiaomin Chen
BACKGROUND/PURPOSE: Experience in procedures combining left atrial appendage (LAA) closure (LAAC) and catheter ablation (CA) was scarce in Chinese nonvalvular atrial fibrillation (AF) patients with high risks for stroke and bleeding. We aimed to investigate the efficacy and safety of the combination therapy with LAAC and AF CA in a single procedure based on the multicenter data and medium-term follow-up results. METHODS: A total of 122 AF patients with a mean CHA2 DS2 -VASc score of 4...
October 25, 2018: Journal of the Formosan Medical Association, Taiwan Yi Zhi
Xiang-Fei Feng, Peng-Pai Zhang, Jian Sun, Qun-Shan Wang, Yi-Gang Li
Left atrial appendage (LAA) closure (LAAC) has emerged as an alternative therapeutic approach to medical therapy for stroke prevention in patients with nonvalvular atrial fibrillation (NVAF). However, complex LAA anatomy may preclude its use. LAmbre is a new, self-expanding LAA occluder, and is highly adaptable to different LAA morphologies. We explored the feasibility, safety, and efficacy of LAAC using LAmbre device in NVAF patients with or without prior catheter ablation (CA). LAAC using LAmbre device was applied in NVAF patients with (group C) or without (group N) prior CA...
November 20, 2018: International Heart Journal
Dan Musat, Suneet Mittal
The thrombus formed within the LAA is responsible for the vast (about 90%) majority of strokes. Anticoagulation, although effective therapy for stroke prevention is not feasible in a significant minority of patients due to various reasons. Two percutaenous LAA exclusion techniques have been developed in an effort to decrease risk for stroke: endocardial closure/plugging of the LAA (Watchman, Amplatzer devices) and epicardial LAA ligation (LARIAT). The aim of this study is to review the trial data to date for the LARIAT device...
June 2018: Journal of Atrial Fibrillation
Ramez Morcos, Haider Al Taii, Priya Bansal, Joel Casale, Rupesh Manam, Vikram Patel, Anthony Cioci, Michael Kucharik, Arjun Malhotra, Brijeshwar Maini
Periprocedural imaging assessment for percutaneous Left Atrial Appendage (LAA) transcatheter occlusion can be obtained by utilizing different imaging modalities including fluoroscopy, magnetic resonance imaging (MRI), computed tomography (CT), and ultrasound imaging. Given the complex and variable morphology of the left atrial appendage, it is crucial to obtain the most accurate LAA dimensions to prevent intra-procedural device changes, recapture maneuvers, and prolonged procedure time. We therefore sought to examine the accuracy of the most commonly utilized imaging modalities in LAA occlusion...
November 14, 2018: Journal of Clinical Medicine
Michele Conti, Stefania Marconi, Giuseppe Muscogiuri, Marco Guglielmo, Andrea Baggiano, Gianpiero Italiano, Maria Elisabetta Mancini, Ferdinando Auricchio, Daniele Andreini, Mark G Rabbat, Andrea Igoren Guaricci, Gaetano Fassini, Alessio Gasparetti, Fabrizio Costa, Claudio Tondo, Anna Maltagliati, Mauro Pepi, Gianluca Pontone
BACKGROUND: We sought to evaluate the additional value of left atrial appendage (LAA) 3D printing derived from computed tomography (CCT) in determining the size for LAA occlusion (LAAO) devices as compared to standard measurement by using occurrence of LAA leak as endpoint. METHODS: We evaluated 6 patients with LAA leak (cases) and 14 matched patients without LAA leak (controls) after LAAO. For each group, a patient-specific 3D printed model of LAA was manufactured using CT pre-operative images...
October 26, 2018: Journal of Cardiovascular Computed Tomography
Giovanni Lorenzoni, Pierluigi Merella, Paolo Pischedda, Gavino Casu
Left atrial appendage (LAA) perforation is a possible complication not only after release of the closure device, but also during the diagnostic phase due to sheath positioning in the LAA. We present an 83-year-old woman with permanent atrial fibrillation and high thromboembolic and bleeding risk who was admitted for elective percutaneous LAA closure. During angiographic study, she suddenly became hypotensive. Heart perforation with leakage of contrast in the pericardial space was evident and imaging confirmed cardiac tamponade...
November 2018: Journal of Invasive Cardiology
Narayana Sarma V Singam, Rakesh Gopinathannair, Jeffrey M Stidam, Naresh K Solankhi, Matthew Bessen, Marcus F Stoddard
The left atrial appendage (LAA) in the setting of non-valvular atrial fibrillation (NVAF) is the predominant location for intracardiac thrombus formation. An absent LAA is a very rare congenital cardiac anomaly. We present a case of a 79-year-old female with NVAF, high CHADS2VASC2 score, and high bleeding risk who presented for elective Watchman™ left atrial appendage closure device implant. A pre-procedural transesophageal echocardiography showed an absent LAA. This finding was confirmed with cardiac computed tomography and a left atrial angiogram...
October 18, 2018: Echocardiography
Kazutaka Aonuma, Hiro Yamasaki, Masato Nakamura, Tatsushi Ootomo, Morimasa Takayama, Kenji Ando, Kenzo Hirao, Yoshihiro Morino, Kentaro Hayashida, Kengo Kusano, Michael L Main, Shigeru Saito
BACKGROUND: The PROTECT AF and PREVAIL trials demonstrated that the WATCHMAN left atrial appendage (LAA) closure device is a reasonable alternative to warfarin therapy for stroke prevention in patients with nonvalvular atrial fibrillation (NVAF) in the USA and Europe. We conducted the SALUTE trial to confirm the safety and efficacy of the LAA closure therapy for patients with NVAF in Japan. Methods and Results: A total of 54 subjects (including 12 Roll-in) with NVAF who had a CHA2 DS2 -VASc score ≥2 were enrolled...
October 11, 2018: Circulation Journal: Official Journal of the Japanese Circulation Society
Basel Ramlawi, Kareem Bedeir, James R Edgerton
The left atrial appendage (LAA) is a major site of clot formation in atrial fibrillation. Stand-alone thoracoscopic LAA complete closure can decrease stroke risk and may be an alternative to life-long oral anticoagulation.1 We describe our technique for totally thoracoscopic LAA exclusion with an epicardial clip device. This approach provides a safe and likely more effective alternative to LAA management than other endocardial devices.
September 18, 2018: Annals of Thoracic Surgery
Kaveh Oraii Yazdani, Satoru Mitomo, Neil Ruparelia, Luciano Candilio, Francesco Giannini, Richard J Jabbour, Damiano Regazzoli, Patrizio Mazzone, Stefano Stella, Nicoleta Sora, Matteo Montorfano, Antonio Colombo, Azeem Latib
OBJECTIVE: To investigate the effect of left atrial appendage (LAA) occlusion device positioning upon periprocedural and long-term outcomes. BACKGROUND: The Amulet device is designed to cover the ostium of the LAA. Prolapse of the device into the neck of the LAA is not uncommon resulting in incomplete coverage of the ostium. The clinical consequences of this remain uncertain. METHODS: Outcomes of 87 patients with successful LAA closure were analyzed according to Amulet disc position: group A (n = 45) had complete LAA ostium coverage; group B (n = 42) had incomplete ostium coverage because of disc prolapse...
August 5, 2018: Catheterization and Cardiovascular Interventions
Paolo A Pagnotta, Mauro Chiarito, Elton Pllaha, Dennis Zavalloni Parenti, Marco L Rossi, Riccardo Mantovani, Francesco Pisano, Giulio G Stefanini, Bernhard Reimers
AIMS: Left atrial appendage (LAA) closure is considered an effective option in patients with non-valvular atrial fibrillation (NVAF) and contraindications to long-term oral anticoagulant (OAC) therapy. However, there are some concerns about safety of currently available devices. Our aim is to provide an initial assessment on feasibility and safety of the novel LAA closure Ultraseal device in patients with NVAF and contraindications to long-term OAC therapy. METHODS: Twenty-three consecutive patients with NVAF undergoing Ultraseal device implantation between July 2016 and February 2018 at two institutions were included...
July 27, 2018: Journal of Interventional Cardiology
Lucas V A Boersma, Benno J W M Rensing, Lisette I Wintgens, Martijn Klaver, Martin J Swaans
The left atrial appendage (LAA) is the main source of cardioembolic stroke in patients with atrial fibrillation without valvular disease. Oral anticoagulation (OAC) has proven effective for preventing strokes associated with atrial fibrillation but is complicated by inherent bleeding risk and therapeutic compliance. Mechanical closure of the left atrial appendage seems an attractive alternative, especially in patients for whom long-term oral anticoagulation is not a good option. In the past decade, several percutaneous techniques have become available for this, including the WATCHMAN device...
June 15, 2018: Nederlands Tijdschrift Voor Geneeskunde
Christopher R Ellis, Mohamed Metawee, Robert N Piana, Jeremy M Bennett, Mias Pretorius, Robert J Deegan
BACKGROUND: Incomplete surgical left atrial appendage occlusion (S-LAAO) with a narrow neck has been shown to predict an increased rate of embolic stroke. Patients with a previously attempted S-LAAO were systematically excluded from all clinical trials of LAA closure devices. OBJECTIVE: The purpose of this study was to evaluate the feasibility of Watchman LAA device closure for patients referred with chronically incomplete S-LAAO. METHODS: A prospective single-arm feasibility cohort evaluated only subjects undergoing Watchman LAA closure following incomplete S-LAAO...
August 15, 2018: Heart Rhythm: the Official Journal of the Heart Rhythm Society
John J Squiers, James R Edgerton
Occlusion of the left atrial appendage (LAA) may protect against stroke in patients with atrial fibrillation. While percutaneous LAA closure devices have demonstrated efficacy in stroke reduction, surgical LAA occlusion has been performed with mixed results to date. Although surgical exclusion via internal sutures or noncutting stapler is ineffective due to recanalization of the LAA, surgical excision and certain exclusion devices including the AtriClip device are effective methods to achieve complete closure of the LAA...
February 2018: Journal of Atrial Fibrillation
David Nehemiah Majule, Chang Jing, Willfredius Mugishagwe Rutahoile, Felix Samuel Shonyela
The standard treatment for stroke risk patients with non-valvular atrial fibrillation (NVAF) is the use of oral anticoagulants (OACs). However, a substantial number of patients have relative or absolute contraindications to OACs due to concerns of major bleeding risk and other adverse effects while using oral anticoagulation therapy. Recently, occurrences of exclusion of the left atrial appendage (LAA) in patients with contraindication to anticoagulation therapy are widely expanding worldwide, causing major contentious discussions...
June 29, 2018: Annals of Thoracic and Cardiovascular Surgery
Mohit K Turagam, Poonam Velagapudi, Saibal Kar, David Holmes, Vivek Y Reddy, Marwan M Refaat, Luigi Di Biase, Amin Al-Ahmed, Mina K Chung, Thorsten Lewalter, James Edgerton, James Cox, John Fisher, Andrea Natale, Dhanunjaya R Lakkireddy
Left atrial appendage (LAA) closure has evolved as an effective strategy for stroke prevention in patients with atrial fibrillation who are considered suitable for oral anticoagulation. There is strong evidence based on randomized clinical trials with 1 percutaneous device, as well as a large registry experience with several devices, regarding the safety and efficacy of this strategy. In addition, there is encouraging data regarding the effect of epicardial LAA closure on decreasing arrhythmia burden and improvements in systemic homeostasis by neurohormonal modulation...
July 24, 2018: Journal of the American College of Cardiology
Anne-Lise Hachulla, Stéphane Noble, Gabriel Guglielmi, Daniel Agulleiro, Hajo Müller, Jean-Paul Vallée
OBJECTIVES: Correct device sizing for left atrial appendage (LAA) closure remains challenging due to complex LAA shapes. The aim of our study was to investigative the utility of personalized 3D-printed models (P3DPM) of the LAA to guide device size selection. METHODS: Fifteen patients (75.4 ±8.5years) scheduled for LAA closure using an Amulet device underwent cardiac computed tomography (CT). The LAA was segmented by semiautomatic algorithms using Vitrea® software...
June 14, 2018: European Radiology
Nico Reinsch, Ute Ruprecht, Jochen Buchholz, Christoph Edel, Hagen Kälsch, Kars Neven
AIMS: Stroke due to atrial fibrillation has been associated with a high risk of disability and mortality. Percutaneous left atrial appendage (LAA) closure has been established as an alternative strategy for stroke prevention in patients not eligible for oral anticoagulation. The LAmbre is a novel occluder, specifically designed for LAA closure adaptive to various LAA anatomies. The aim of this study was to demonstrate feasibility and initial experience in a nonprescreened patient cohort for LAA occlusion using the novel LAmbre occluder...
September 2018: Journal of Cardiovascular Medicine
Thomas Fink, Michael Schlüter, Roland Richard Tilz, Christian-Hendrik Heeger, Christine Lemes, Tilmann Maurer, Bruno Reissmann, Laura Rottner, Francesco Santoro, Shibu Mathew, Andreas Rillig, Feifan Ouyang, Karl-Heinz Kuck, Andreas Metzner
BACKGROUND: Epicardial left atrial appendage (LAA) ligation may be an alternative to oral anticoagulation management and to endocardial LAA closure devices. We report long-term results after LAA ligation with the second-generation LARIAT device. METHODS: Retrospective study was performed on patients who underwent LAA ligation at our center. Follow-up included patient visits and transesophageal echocardiography (TEE) to assess LAA-to-LA leakages. RESULTS: 76 patients with an indication for LAA closure underwent cardiac CT-based screening with 16 patients (21%) excluded from LAA ligation due to anatomical reasons...
December 2018: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
Mathieu Granier, Guillaume Laugaudin, Franc Massin, Stephane Cade, Pierre Francois Winum, Cornelia Freitag, Jean-Luc Pasquie
AIMS: Percutaneous left atrial appendage (LAA) occlusion is occasionally incomplete, with residual permeability of the LAA on cardiac computed tomography. The cause for this is unclear. Our objective was to determine if residual permeability was related to incomplete endothelialization. METHODS: A total of 35 consecutive patients contraindicated for anticoagulant therapy admitted for LAA occlusion were included; 12 patients received a Watchman device (Boston Scientific) and 23 patients received an Amplatzer Cardiac Plug (St...
July 2018: Journal of Invasive Cardiology
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