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Appendage closure

Christophe O Chantre, Patrick H Campbell, Holly M Golecki, Adrian T Buganza, Andrew K Capulli, Leila F Deravi, Stephanie Dauth, Sean P Sheehy, Jeffrey A Paten, Karl Gledhill, Yanne S Doucet, Hasan E Abaci, Seungkuk Ahn, Benjamin D Pope, Jeffrey W Ruberti, Simon P Hoerstrup, Angela M Christiano, Kevin Kit Parker
Wounds in the fetus can heal without scarring. Consequently, biomaterials that attempt to recapitulate the biophysical and biochemical properties of fetal skin have emerged as promising pro-regenerative strategies. The extracellular matrix (ECM) protein fibronectin (Fn) in particular is believed to play a crucial role in directing this regenerative phenotype. Accordingly, Fn has been implicated in numerous wound healing studies, yet remains untested in its fibrillar conformation as found in fetal skin. Here, we show that high extensional (∼1...
March 5, 2018: Biomaterials
Lisette Wintgens, Aleksandr Romanov, Karen Phillips, Gabriel Ballesteros, Martin Swaans, Richard Folkeringa, Ignacio Garcia-Bolao, Evgeny Pokushalov, Lucas Boersma
Aims: Long-term freedom from atrial fibrillation (AF) after catheter ablation (CA) and consequently the potential for stroke reduction remain unpredictable. Percutaneous left atrial appendage closure (LAAC) is an effective mechanical alternative to oral anticoagulation (OAC) for stroke prevention in AF patients. This study aims to evaluate long-term clinical results of combined CA and LAAC in one single procedure. Methods and results: Patients with non-valvular AF who underwent combined CA and LAAC procedure were included in the retrospective compilation of independent prospective general LAAC registries at the individual centres...
March 13, 2018: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Emmanuel Teiger, Jean-Benoit Thambo, Pascal Defaye, Jean-Sylvain Hermida, Sélim Abbey, Didier Klug, Jean-Michel Juliard, Jean-Luc Pasquie, Gilles Rioufol, Antoine Lepillier, Meyer Elbaz, Jerome Horvilleur, Philippe Brenot, Bertrand Pierre, Philippe Le Corvoisier
BACKGROUND: Percutaneous left atrial appendage (LAA) closure is an emerging option for patients with atrial fibrillation at high risk for cerebrovascular events. The multicenter FLAAC registry (French Nationwide Observational LAA Closure Registry) was established to assess LAA closure outcomes in everyday practice. METHODS AND RESULTS: Four hundred thirty-six patients referred from April 2013 to September 2015 to 33 French interventional cardiology centers for percutaneous LAA closure were included prospectively in the FLAAC registry...
March 2018: Circulation. Cardiovascular Interventions
Matthew J Price
Randomized clinical trials have demonstrated that left atrial appendage (LAA) closure with the WATCHMAN device provides stroke prevention in nonvalvular atrial fibrillation while significantly reducing morality and major bleeding. Technical and procedural considerations are paramount for the therapeutic success. Maximizing procedural safety is critical. Optimal LAA sealing is required. Improvements in procedural technique and operator training have resulted in a marked reduction in adverse procedural events, which should increase the absolute long-term clinical benefit...
April 2018: Interventional Cardiology Clinics
Nicholas Y Tan, Omar Z Yasin, Alan Sugrue, Abdallah El Sabbagh, Thomas A Foley, Samuel J Asirvatham
The left atrial appendage has been implicated as a major nidus for thrombus formation, particularly in atrial fibrillation. This discovery has prompted substantial interest in the development of left atrial appendage exclusion devices aimed at decreasing systemic thromboembolism risk. Its deceptively simple appearance belies the remarkable complexity that characterizes its anatomy and physiology. We highlight the key anatomic features and variations of the left atrial appendage as well as its relationships with surrounding structures...
April 2018: Interventional Cardiology Clinics
Tawseef Dar, Mohit K Turagam, Bharath Yarlagadda, Mohmad Tantary, Seth H Sheldon, Dhanunjaya Lakkireddy
Left atrial appendage closure (LAAC) has emerged as a viable option for stroke prevention, especially in those intolerant of or not suitable for long-term oral anticoagulation therapy. This article describes the clinical characteristics, indications, and a proposed referral system for potential LAAC patients. Patient selection remains a challenge because of the paradox between the available randomized data on this intervention and the actual patient population who may gain maximum benefit. Further investigations comparing different LAAC devices with each other and with novel oral anticoagulants are needed...
April 2018: Interventional Cardiology Clinics
Matthew J Price
Resection of the left atrial appendage (LAA) to prevent recurrent arterial emboli in patients with atrial fibrillation was first suggested more than 60 years ago. Longer-term follow-up from randomized studies of the safety and efficacy of transcatheter LAA occlusion has recently been completed; data from large, observational cohorts are being reported. These recent data provide further insights into procedural safety with current techniques and the ability of LAA closure to reduce thromboembolic stroke compared with warfarin anticoagulation...
April 2018: Interventional Cardiology Clinics
Bernhard Meier, Wim Stegink, Apostolos Tzikas
AMPLATZER devices preceded WATCHMAN occluder in 2002 for catheter-based left atrial appendage occlusion. The AMPLATZER technique facilitates simultaneous closure of atrial shunts using two devices through one gear. Randomized WATCHMAN follow-up data showed a mortality benefit over warfarin. AMPLATZER data make this likely valid for the strategy. Particularly young people with atrial fibrillation should be offered left atrial appendage occlusion because the risk is confined to the intervention and early postintervention period...
April 2018: Interventional Cardiology Clinics
Patrizio Mazzone, Giuseppe D'Angelo, Damiano Regazzoli, Giulio Molon, Gaetano Senatore, Salvatore Saccà, Guido Canali, Claudia Amellone, Riccardo Turri, Paolo Della Bella
PURPOSE: The WATCHMAN device for Left Atrial Appendage Occlusion (LAAO) has proven to be an effective alternative to oral anticoagulation (OAC) in patients with atrial fibrillation (AF), and has now been adopted in clinical practice. In the present study, we analyzed the safety and efficacy profile of the LAAO procedure at mid-term follow-up. METHODS: The TRAPS Registry is an observational, multicenter registry involving four Italian centers. Consecutive patients who had undergone LAAO with WATCHMAN device were enrolled...
March 10, 2018: Journal of Interventional Cardiac Electrophysiology: An International Journal of Arrhythmias and Pacing
Christian Fastner, Christoph A Nienaber, Jai-Wun Park, Johannes Brachmann, Uwe Zeymer, Martin Goedde, Horst Sievert, Volker Geist, Thorsten Lewalter, Alexander Krapivsky, Matthias Käunicke, Jens Maier, Belgin Özdemir, Matthias Hochadel, Steffen Schneider, Jochen Senges, Ibrahim Akin
AIMS: The interventional left atrial appendage closure (LAAC) is an emerging alternative to oral anticoagulation (OAC) for stroke prevention in atrial fibrillation (AF) in concomitance with a contraindication for standard OAC. This subanalysis of the LAARGE registry aims to investigate on differences between different LAA morphologies in a real-world setting. METHODS AND RESULTS: This prospective, multicenter, observational registry included 562 patients from 37 centers with ineligibility for long-term OAC between April 2014 and January 2016...
March 6, 2018: EuroIntervention
Albert C Lin, Bradley P Knight
Interventional catheter ablation approaches to the rhythm control of atrial fibrillation (AF) have advanced significantly in the past decade. The foundation of the catheter ablation in AF is electrical isolation of the pulmonary veins (PVI). However, PVI only in more advanced stages of AF (persistent AF) has only modest to poor success rates prompting a search for alternative and adjunctive procedures to improve the outcomes of ablation in persistent AF. The left atrial appendage (LAA) is well understood to be a primary source of emboli in AF but less well known be a trigger or driver for AF...
March 6, 2018: Current Treatment Options in Cardiovascular Medicine
Marco Angelillis, Giuseppe Gargiulo, Aris Moschovitis, Monika Fürholz, Samera Shakir, Nicolo Piazza, Lorenz Räber, Bernhard Meier, Steffen Gloekler, Stephan Windecker, Marco Valgimigli
No abstract text is available yet for this article.
March 2, 2018: International Journal of Cardiology
Tawseef Dar, Bharat Yarlagadda, James Vacek, Buddhadeb Dawn, Dhanunjaya Lakkireddy
Background: Bleeding complications especially gastrointestinal bleeding remains a major challenge associated with oral anticoagulation therapy (OAT) and often leads clinicians to withdraw oral anticoagulation therapy (OAT) . This exposes patients to risk of stroke and systemic thromboembolism (STE). Novel oral anticoagulants (NOACs) have proved no better when it comes to bleeding events and in fact studies have shown that overall NOACs are associated with higher incidence of gastrointestinal (GI) bleeding compared to warfarin ...
December 2017: Journal of Atrial Fibrillation
Sacha Salzberg, Maximillian Emmert
Left atrial appendage closure was originally described by Madden in 1949 who was the first to perform appendix amputation. This was a very invasive procedure with poor outcome, but preformed for stroke prevention. Much later, it was James Cox whom described the Cox-Maze procedure, which included multiple incisions to create a maze like pathway for the electrical impulse to go undisturbed from the sinus node down to the atrio-ventricular node. Since then cardiac surgeons stopped focusing on the left atrial appendage and went on about seemingly more important things...
December 2017: Journal of Atrial Fibrillation
Kathirvel Subramaniam, Andrea Ibarra, Michael L Boisen
In this report, we provided details of periprocedural echocardiographic guidance for patients undergoing Amplatzer-Amulet device left atrial closure. Familiarity with left atrial appendage (LAA) occlusion devices and the required left atrial examination and measurements are key before device placement. Device placement is assisted by transesophageal echocardiography (TEE) and fluoroscopy, but TEE will be the main guide for patients with renal insufficiency in whom contrast dye use needs to be minimal. TEE is also used to confirm LAA occlusion with the device and finally detect complications throughout the procedure and into the postoperative period...
February 1, 2018: Seminars in Cardiothoracic and Vascular Anesthesia
Jayson R Baman, Moussa Mansour, E Kevin Heist, David T Huang, Yitschak Biton
Atrial fibrillation is commonly coexistent with heart failure, and the management of the heart failure patient would be incomplete without an appreciation for atrial fibrillation management. There are many complications associated with oral anticoagulation in the prevention of stroke related to atrial fibrillation. In recent years, the advent of several percutaneous left atrial appendage (LAA) occlusion/closure strategies has sought to provide an alternative treatment modality. Here, we systematically review the published literature to investigate the efficacy and safety of percutaneous LAA occlusion/closure devices...
February 17, 2018: Heart Failure Reviews
P Kamtchueng
No abstract text is available yet for this article.
February 2018: Journal de Médecine Vasculaire
Mohamad Alkhouli, David M Campsey, Bryan Raybuck, James Mills
No abstract text is available yet for this article.
February 6, 2018: European Heart Journal
Christian Fastner, Michael Behnes, Benjamin Sartorius, Annika Wenke, Siegfried Lang, Gökhan Yücel, Katherine Sattler, Jonas Rusnak, Ahmad Saleh, Christian Barth, Kambis Mashayekhi, Ursula Hoffmann, Martin Borggrefe, Ibrahim Akin
BACKGROUND: Left atrial appendage closure (LAAC) represents the interventional alternative to oral anticoagulation for stroke prevention in atrial fibrillation (AF). The metabolism of acylcarnitines was shown to affect cardiovascular diseases. This study evaluates the influence of successful LAAC on the metabolism of acylcarnitines. METHODS: Patients undergoing successful LAAC were enrolled prospectively. Peripheral blood samples for metabolomics measurements were collected immediately before (i...
February 7, 2018: International Journal of Molecular Sciences
Elif Gokcal, Marco Pasi, Marc Fisher, M Edip Gurol
PURPOSE OF REVIEW: This review aims to help neurologists managing atrial fibrillation (AF) patients who had an ischemic stroke and/or with intracranial hemorrhage (ICH) markers, therefore at high embolic/hemorrhagic risks. RECENT FINDINGS: Implantable loop recorders have substantially improved the accuracy of AF detection. Recent research yielded a set of powerful neuroimaging markers that can stratify ICH risk. Direct oral anticoagulants (DOAC) are easier to use with a lower ICH risk than warfarin in a general AF population...
February 6, 2018: Current Neurology and Neuroscience Reports
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