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Appendage closure

Shigeaki Aoyagi, Eiki Tayama, Takeshi Oda, Tomokazu Kosuga, Hiroshi Yasunaga
In patients with atrial fibrillation, closure of the left atrial appendage (LAA) is recommended to prevent thromboembolic events, however, conventional exclusion or excision techniques have potential drawbacks such as persistent blood flow into the appendage and a residual stump. We propose a simple and easy technique for LAA closure consisting of intra-atrial excision of the LAA, which is invaginated into the left atrium (LA), and direct suture closure of the orifice from inside the LA. In this technique, complete elimination of the LAA was achieved without leaving a residual stump because the LAA was excised at the orifice and was closed at the base of the LAA...
September 9, 2016: Heart, Lung & Circulation
Lim Eng, Jacqueline Saw
No abstract text is available yet for this article.
September 2016: Journal of Thoracic Disease
Xavier Freixa, Laura Llull, Sameer Gafoor, Ignacio Cruz-Gonzalez, Samera Shakir, Heyder Omran, Sergio Berti, Gennaro Santoro, Joelle Kefer, Ulf Landmesser, Jens Erik Nielsen-Kudsk, Prapa Kanagaratnam, Fabian Nietlispach, Steffen Gloekler, Adel Aminian, Paolo Danna, Marco Rezzaghi, Friederike Stock, Miroslava Stolcova, Luis Paiva, Marco Costa, Xavier Millán, Reda Ibrahim, Tobias Tichelbäcker, Wolfgang Schillinger, Jai-Wun Park, Horst Sievert, Bernhard Meier, Apostolos Tzikas
Cardioembolic strokes are generally more lethal and disabling than other source of strokes. Data from PROTECT AF (Watchman Left Atrial Appendage Closure Technology for Embolic Protection in Patients With Atrial Fibrillation) suggest that strokes after left atrial appendage occlusion (LAAO) with the Watchman device are less disabling than those in the warfarin group. No data assessing the severity of strokes after LAAO with the AMPLATZER Cardiac Plug (ACP) are available. The objective of the study was to evaluate the severity of cerebrovascular events after LAAO with the ACP in a population mostly characterized by an absolute or relative contraindication to oral anticoagulation...
September 15, 2016: American Journal of Cardiology
Zhonghua Sun, Yanmin Zhou, Ding Zhou, Yat-Yin Lam, Yunzhou Huang, Jian Zhang, Yuanlu Chen, Xiangqian Qi
No abstract text is available yet for this article.
October 1, 2016: International Journal of Cardiology
Ignacio Cruz-González, Juan C Rama-Merchan, Sandra Martínez-Peralta, Luis López-Mesonero, Javier Rodríguez-Collado, Pedro L Sánchez
No abstract text is available yet for this article.
October 5, 2016: Revista Española de Cardiología
Andrea Radinovic, Patrizio Mazzone, Giovanni Landoni, Eustachio Agricola, Damiano Regazzoli, Paolo Della Bella
BACKGROUND: Left atrial catheterization through transseptal puncture is frequently performed in cardiac catheterization procedures. Appropriate transseptal puncture is critical to achieve procedural success. AIMS: The aim of the study is to evaluate the feasibility of selective transseptal punctures, using a modified radiofrequency (RF) transseptal needle and transesophageal echocardiography (TEE), in different types of procedures that require specific sites of left atrial catheterization...
October 2016: Annals of Cardiac Anaesthesia
Navkaranbir S Bajaj, Rajat Kalra, Nirav Patel, Taimoor Hashim, Hemant Godara, Sameer Ather, Garima Arora, Tilak Pasala, Thomas T Whitfield, David C McGiffin, Mustafa I Ahmed, Steven G Lloyd, Nita A Limdi, Pankaj Arora
BACKGROUND: Multiple novel oral anticoagulants and left atrial appendage closure devices (WATCHMAN) have been tested against dose-adjusted vitamin K antagonists in randomized controlled trials for stroke prophylaxis in non-valvular atrial fibrillation. No direct comparisons of these strategies are available from randomized controlled trials. We conducted the current analyses by combining efficacy and safety characteristics of all FDA approved stroke prophylaxis treatment strategies for patients with non-valvular atrial fibrillation...
2016: PloS One
Erin A Fender, Jawad G Kiani, David R Holmes
PURPOSE OF REVIEW: Anticoagulant therapy effectively reduces the incidence of stroke in patients with atrial fibrillation (AF) but is underutilized and frequently contraindicated. The left atrial appendage (LAA) is the primary site of thrombus formation in AF patients. Surgical and percutaneous appendage closure has been evaluated as a site-specific therapy to reduce systemic thromboembolism. RECENT FINDINGS: We will review LAA closure techniques, examine recent outcome data, and discuss the indications for, and potential complications of, each approach...
November 2016: Current Atherosclerosis Reports
Daniele Gemma, Raúl Moreno Gómez, Jaime Fernández de Bobadilla, Guillermo Galeote García, Teresa López Fernandez, Jose R López-Mínguez, José L López-Sendón
Mitral stenosis (MS) is frequently associated with the development of atrial fibrillation (AF) as a consequence of hemodynamic and inflammatory changes in the left atrium. Both conditions predispose to thrombus formation, with frequent involvement of the left atrial appendage (LAA), and consequent increase in the incidence of systemic thromboembolic events. Percutaneous mitral valvuloplasty (PMV) reduces the risk of thromboembolism in patients with significant mitral stenosis. Percutaneous LAA closure is also associated with a reduction in thromboembolic risk in patients with AF, but there are no data regarding the use of this technique in patients with significant mitral valve disease...
September 29, 2016: Portuguese Journal of Cardiology: An Official Journal of the Portuguese Society of Cardiology
Yae Matsuo, Petr Neuzil, Jan Petru, Milan Chovanec, Marek Janotka, Subbarao Choudry, Jan Skoda, Lucie Sediva, Masahiko Kurabayashi, Vivek Y Reddy
BACKGROUND: Transcatheter left atrial appendage closure is an alternative therapy for stroke prevention in atrial fibrillation patients. These procedures are currently guided with transesophageal echocardiography and fluoroscopy in most centers. As intracardiac echocardiography (ICE) is commonly used in other catheter-based procedures, we sought to determine the safety and effectiveness of intracardiac echocardiography-guided left atrial appendage closure with the Watchman device. METHODS AND RESULTS: A total of 27 patients (11 males, 77...
2016: Journal of the American Heart Association
Peter Fahmy, Lim Eng, Jacqueline Saw
Percutaneous left atrial appendage (LAA) closure is gaining interest as an alternative option for prevention of strokes in patients with Atrial Fibrillation (AF), especially for those with contraindications to anticoagulation. Complications from these procedures are well described in the medical literature. LAA closures may lead to pericardial effusion, device-associated thrombus, and device embolization. Understanding the reasons for embolization, strategies to avoid embolization, and the techniques for retrieval of LAA devices (ACP/AMULET and WATCHMAN) should be appreciated by endovascular implanters...
September 28, 2016: Catheterization and Cardiovascular Interventions
Antonio H Frangieh, Jasmina Alibegovic, Christian Templin, Oliver Gaemperli, Slayman Obeid, Robert Manka, Erik W Holy, Willibald Maier, Thomas F Lüscher, Ronald K Binder
BACKGROUND: Left atrial appendage occlusion (LAAO) is mostly performed by transesophageal echocardiography (TEE) guidance. Intracardiac echocardiography (ICE) may be an alternative imaging modality for LAAO that precludes the need for general anesthesia or sedation. METHODS AND RESULTS: All consecutive single center, single operator LAAO candidates were analyzed. Baseline clinical and procedural characteristics and in-hospital outcomes were compared between patients in whom a Watchman was implanted with ICE vs...
September 21, 2016: Catheterization and Cardiovascular Interventions
A Schmermund, J Eckert, S N Schelle, H Eggebrecht
For the treatment of structural heart disease, current options in the catheterization laboratory include MitraClip® implantation for treating severe mitral regurgitation, transcatheter aortic valve implantation (TAVI), closure of a patent foramen ovale (PFO) and occlusion of the left atrial appendage (LAA). These treatment options are based on a precise diagnosis provided by modern cardiac imaging, which is indispensable for treatment recommendations. Its importance for supporting the invasive procedures in the catheterization laboratory is less well known...
September 19, 2016: Herz
Jonathan P Piccini, Horst Sievert, Manesh R Patel
Atrial fibrillation (AF) is a worldwide epidemic associated with significant morbidity and mortality, often due to disabling or fatal thromboembolic stroke. Oral anticoagulation is highly effective at preventing ischaemic stroke and improving all-cause survival in patients with non-valvular AF. Despite the efficacy of oral anticoagulation, many patients are not treated due to either absolute or perceived contraindications to therapy, including bleeding. Left atrial appendage (LAA) closure has emerged as a mechanical alternative to pharmacologic stroke prevention...
September 13, 2016: European Heart Journal
Martin J Swaans, Lisette Is Wintgens, Arash Alipour, Benno Jwm Rensing, Lucas Va Boersma
Atrial fibrillation (AF) is the most common arrhythmia treated in the clinical practice. One of the major complications of AF is a thromboembolic cerebral ischemic event. Up to 20% of all strokes are caused by AF. Thromboembolic cerebral ischemic event in patients with AF occurs due to atrial thrombi, mainly from the left atrial appendage (LAA). Prevention of clot formation with antiplatelet agents and especially oral anticoagulants (vitamin K antagonists or newer oral anticoagulants) has been shown to be effective in reducing the stroke risk in patients with AF but has several drawbacks with (major) bleedings as the most important disadvantage...
2016: Medical Devices: Evidence and Research
Marziyeh Ranjbar-Mohammadi, Shahram Rabbani, S Hajir Bahrami, M T Joghataei, F Moayer
In this study we describe the potential of electrospun curcumin-loaded poly(ε-caprolactone) (PCL)/gum tragacanth (GT) (PCL/GT/Cur) nanofibers for wound healing in diabetic rats. These scaffolds with antibacterial property against methicillin resistant Staphylococcus aureus as gram positive bacteria and extended spectrum β lactamase as gram negative bacteria were applied in two forms of acellular and cell-seeded for assessing their capability in healing full thickness wound on the dorsum of rats. After 15days, pathological study showed that the application of GT/PCL/Cur nanofibers caused markedly fast wound closure with well-formed granulation tissue dominated by fibroblast proliferation, collagen deposition, complete early regenerated epithelial layer and formation of sweat glands and hair follicles...
December 1, 2016: Materials Science & Engineering. C, Materials for Biological Applications
Guillaume Bonnet, Erwan Salaun, Mathieu Pankert, Thomas Cuisset, Jean-Louis Bonnet
BACKGROUND: Left atrial appendage (LAA) closure using the WATCHMAN™ device (WM) may be considered in patients with non-valvular atrial fibrillation (AF) and a high-risk of stroke who are ineligible for long-term oral anticoagulation (OAC). AIM: To report our single-centre preliminary experience, focusing on feasibility, safety and short-term efficacy of this procedure. METHODS: Patients implanted from December 2013 to February 2014 were included...
September 1, 2016: Archives of Cardiovascular Diseases
Mathias Lange, Helmut Bültel, Heinrich Weglage, Patrick Löffeld, Thomas Wichter
A 73-year-old patient with permanent atrial fibrillation presented for left atrial appendage (LAA) occlusion. Transesophageal echocardiography demonstrated a thrombus in the distal LAA. This image series illustrates a "no touch" technique that was used to ensure successful implantation of an Amplatzer Amulet LAA occlusion device without the use of an embolization protection system.
September 2016: Journal of Invasive Cardiology
Shweta Sahay, Luis Nombela-Franco, Josep Rodes-Cabau, Pilar Jimenez-Quevedo, Pablo Salinas, Corina Biagioni, Ivan Nuñez-Gil, Nieves Gonzalo, Jose Alberto de Agustín, Maria Del Trigo, Leopoldo Perez de Isla, Antonio Fernández-Ortiz, Javier Escaned, Carlos Macaya
BACKGROUND: The effectiveness of vitamin K antagonist (VKA) versus placebo and antiplatelet therapy (APT) is well established for stroke prevention in atrial fibrillation (AF). Non-vitamin K antagonist oral anticoagulants (NOAC) are mostly superior to VKA in stroke and intracranial bleeding prevention. Recent randomised controlled trials (RCTs) suggested the non-inferiority of percutaneous left atrial appendage closure (LAAC) versus VKA. However, comparisons between LAAC versus placebo, APT or NOAC are lacking...
September 1, 2016: Heart: Official Journal of the British Cardiac Society
Gavino Casu, Michele Massimo Gulizia, Giulio Molon, Patrizio Mazzone, Andrea Audo, Giancarlo Casolo, Emilio Di Lorenzo, Michele Portoghese, Christian Pristipino, Renato Pietro Ricci, Sakis Themistoclakis, Luigi Padeletti, Claudio Tondo, Sergio Berti, Jacopo Andrea Oreglia, Gino Gerosa, Marco Zanobini, Gian Paolo Ussia, Giuseppe Musumeci, Francesco Romeo, Roberto Di Bartolomeo
Atrial fibrillation (AF) is the most common arrhythmia and its prevalence is increasing due to the progressive aging of the population. About 20% of strokes are attributable to AF and AF patients are at 5-fold increased risk of stroke. The mainstay of treatment of AF is the prevention of thromboembolic complications with oral anticoagulation therapy. Drug treatment for many years has been based on the use of vitamin K antagonists, but recently newer and safer molecules have been introduced (dabigatran etexilate, rivaroxaban, apixaban and edoxaban)...
July 2016: Giornale Italiano di Cardiologia
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