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Left Atrial Appendage Ligation And Exclusion Technology In The Incubator.

ABSTRACT: Stroke is the most feared complication of atrial fibrillation (AF). Targeting the left atrial appendage (LAA) mechanically is attractive as a means to simultaneously reduce stroke risk, the need for anticoagulation, and hemorrhagic complications in patients with non-valvular AF. The results of the PROTECT-AF and PREVAIL randomized clinical trials support this approach as a viable therapeutic alternative to warfarin in selected patients and add to accumulating evidence regarding the importance of the LAA in thromboembolism in AF. A number of devices for percutaneous LAA closure are under investigation or development. In this article, key design features of these ligation and exclusion technologies will be discussed, with a focus on aspects of LAA morphology, relational anatomy, thrombosis, and thromboembolism relevant for successful device development and deployment.

SUBMITTER: Syed FF

PROVIDER: S-EPMC4829965 | biostudies-literature | 2015 Aug-Sep

REPOSITORIES: biostudies-literature

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Left Atrial Appendage Ligation And Exclusion Technology In The Incubator.

Syed Faisal F FF Noheria Amit A DeSimone Christopher V CV Asirvatham Samuel J SJ

Journal of atrial fibrillation 20150831 2

Stroke is the most feared complication of atrial fibrillation (AF). Targeting the left atrial appendage (LAA) mechanically is attractive as a means to simultaneously reduce stroke risk, the need for anticoagulation, and hemorrhagic complications in patients with non-valvular AF. The results of the PROTECT-AF and PREVAIL randomized clinical trials support this approach as a viable therapeutic alternative to warfarin in selected patients and add to accumulating evidence regarding the importance of ...[more]

PMID: 27957184

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Project description:ObjectivesWe demonstrate the feasibility and safety of robotics-assisted left atrial appendage clip exclusion in clinical practice.MethodsAnalysis of a single center robotics-assisted left atrial appendage clip exclusion experience using an epicardial linear clip device in patients with atrial fibrillation with high-risk of thromboembolic stroke and intolerance to oral anticoagulants.ResultsDuring the period from December 2017 to September 2020, we performed 42 robotics-assisted left atrial appendage clip exclusions in response to increased risk of bleeding in patients with atrial fibrillation and intolerance to oral anticoagulants. The average congestive heart failure, hypertension, age, diabetes, stroke, and vascular disease score was 5.2 ± 1.6 and hypertension, abnormal liver or kidney function, stroke, bleeding, labile international normalized ratio, elderly, drugs (aspirin, other antiplatelets, or anticoagulants) score was 4.5 ± 0.9. No patients died intraoperatively or within 30 days, or due to conversion to thoracotomy, intraoperative complications, or failure to apply the clip satisfactorily. The procedure was successfully completed despite pericardial adhesions in 2 patients with prior coronary bypass grafts and 3 with postpericarditis scars. Intraoperative transesophageal echocardiography was performed in 38 out of 42 patients; satisfactory exclusion with left atrial appendage stump <5 mm was confirmed in all. Average length of stay was 3.4 ± 3 days with 12 out of 42 patients discharged within 24 hours. Oral anticoagulants were discontinued in 41 out of 42 patients and no cases of 30-day stroke, myocardial ischemia, or new arrhythmias were observed. One case of hemothorax required thoracoscopy a day later. There was no reported thromboembolic stroke or transient ischemic attack at 12 months. One case of late lacunar stroke was due to in situ small intracranial vessel thrombosis without left atrial appendage thrombus on imaging.ConclusionsRobotics-assisted left atrial appendage clip exclusion is a safe and feasible minimally invasive method for left atrial appendage management in patients with atrial fibrillation with intolerance to oral anticoagulants and increased risk of thromboembolic stroke.

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Left Atrial Appendage Ligation And Exclusion Technology In The Incubator.

Publications

Left Atrial Appendage Ligation And Exclusion Technology In The Incubator.

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