Use of a Novel Septal Occluder Device for Left Atrial Appendage Closure in Patients With Postsurgical and Postlariat Leaks or Anatomies Unsuitable for Conventional Percutaneous Occlusion.

Title

Use of a Novel Septal Occluder Device for Left Atrial Appendage Closure in Patients With Postsurgical and Postlariat Leaks or Anatomies Unsuitable for Conventional Percutaneous Occlusion.

Creator

Della Rocca DG; Horton RP; Tarantino N; Van Niekerk CJ; Trivedi C; Chen Q; Mohanty S; Anannab A; Murtaza G; Akella K; Gianni C; Bassiouny M; Ahmadian-Tehrani A; Al-Ahmad A; Burkhardt JD; Natale VN; Price M; Gallinghouse GJ; Gibson DN; Lakkireddy D; Di Biase L; Natale A

Publisher

Circulation: Cardiovascular Interventions

Date

2020
2020-09-18

Description

BACKGROUND: Interventional therapies aiming at excluding the left atrial appendage (LAA) from systemic circulation have been established as a valid alternative to oral anticoagulation in patients at high thromboembolic risk. However, their efficacy on stroke prophylaxis may be compromised owing to incomplete LAA closure. Additionally, the need for an alternative thromboembolic prevention may remain unmet in patients with contraindications to oral anticoagulation whose appendage anatomy is unsuitable for some conventional devices commercially available. We aimed at evaluating the feasibility of LAA closure with the novel Gore Cardioform Septal Occluder in patients with incomplete appendage ligation or anatomic features which do not meet the manufacturer's requirements for Watchman deployment. METHODS: Twenty-one consecutive patients (mean age: 72±6 years; 85.7% males; CHA(2)DS(2)-VASc: 4.5±1.4; HAS-BLED: 3.6±1.0) were included. Transesophageal echocardiography was performed within 2 months to assess for residual LAA patency. RESULTS: Fourteen patients had incomplete LAA closure following surgical (n=6) or Lariat ligation (n=8). In 7 patients with an appendage anatomy unsuitable for Watchman deployment, the mean maximal landing zone size and LAA depth were 14.4±1.3and 18.6±2.8 mm. Successful Cardioform Septal Occluder deployment was achieved in all patients. No peri-procedural complications were documented.Procedure and fluoroscopy times were 46±13 and 14±5 minutes. Follow-up transesophageal echocardiography after 58±9 days revealed complete LAA closure in all patients. CONCLUSIONS: Transcatheter LAA closure via a Cardioform Septal Occluder device might be a valid alternative in patients with residual leaks following failed appendage ligation or whose LAA anatomy does not meet the minimal anatomic criteria to accommodate a Watchman device.

Subject

atrial fibrillation; patent foramen ovale; mitral valve; atrial appendage; transoesophageal echocardiography

Rights

Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).

Format

journalArticle

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Pages

CIRCINTERVENTIONS120009227

ISSN

1941-7632 1941-7640

Update Year & Number

Hospital List

Citation

Della Rocca DG; Horton RP; Tarantino N; Van Niekerk CJ; Trivedi C; Chen Q; Mohanty S; Anannab A; Murtaza G; Akella K; Gianni C; Bassiouny M; Ahmadian-Tehrani A; Al-Ahmad A; Burkhardt JD; Natale VN; Price M; Gallinghouse GJ; Gibson DN; Lakkireddy D; Di Biase L; Natale A, “Use of a Novel Septal Occluder Device for Left Atrial Appendage Closure in Patients With Postsurgical and Postlariat Leaks or Anatomies Unsuitable for Conventional Percutaneous Occlusion.,” NEOMED Bibliography Database, accessed May 9, 2021, https://neomed.omeka.net/items/show/11443.

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