Left Atrial Appendage Occlusion Using the Novel Amplatzer Steerable Delivery Sheath Combine With FEops HEARTguide

Author(s):  
Ignacio Cruz González ◽  
Pablo J. Antúnez Muiños ◽  
Sergio López Tejero ◽  
Jean Carlos Núñez García ◽  
Javier Rodríguez Collado ◽  
...  
CASE ◽  
2018 ◽  
Vol 2 (6) ◽  
pp. 297-300 ◽  
Author(s):  
Alan F. Vainrib ◽  
Daniel Bamira ◽  
Ricardo J. Benenstein ◽  
Anthony Aizer ◽  
Larry A. Chinitz ◽  
...  

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
V O Vij ◽  
B Al-Kassou ◽  
D Nelles ◽  
M Stuhr ◽  
R Schueler ◽  
...  

Abstract Background Left atrial appendage occlusion (LAAo) is an established therapy in patients with atrial fibrillation. However, criteria regarding optimal device position are not well defined making comparability of procedural results virtually impossible. We therefore sought to a) introduce a classification describing optimal vs. suboptimal device-position by assessing predefined parameters in transoesophageal echocardiography (TEE) and to b) analyze the impact of device-position on outcome in patients treated with different LAAo devices. Methods and results We retrospectively analyzed 120 patients who were treated by LAAo and had undergone follow-up TEEs after 3 or 6 months. Patients were at mean age: 76±8 years; female 40% and presented an increased CHADS-VASC- (4.6±1.4) and HAS-BLED-score (3.7±1). TEE-guidance was performed in all cases. In 62.5% (75/120) pacifier occluders (PO) (ACP/Amulet, Lambre, Ultraseal) were used, whereas 37.5% (45/120) were treated with non-pacifier occluders (NPO) (Watchman, Wavecrest, Occlutech). To assess device position, TEE images in a commissural view (60–90°) were analyzed and characterised by 1) implantation depth in the left atrial appendage, 2) peridevice flow (PF) and 3) the angle between occluder disc and pulmonal ridge (LUPV). For the purpose of this study, optimal device position was defined as a) ostial (LUPV length <10mm) or slightly subostial position (LUPV length ≤15mm, angle ≥100°) with b) the absence of major PF (>3mm). Overall, occluders were implanted at a depth of 12±7.8 mm with ostial positioning being achieved in 47.5% (57/120). Major PF was seen in 7.5% (9/120). NPOs were implanted deeper than POs (depth: 15.6±7.1 vs. 9.8±7.4 mm, p<0.01; ostial position: 31.1% vs. 57.3%, p<0.01) and were associated with a higher incidence of major PF (15.6% vs. 2.7%, p=0.01). Also, the depth/angle ratio was higher (i.e. “worse”) in NPOs (18.3±9 vs. 14.6±8, p<0.04). As a result, optimal device position was achieved in 48.3% (58/120) of all patients, with lower rates in NPOs than in POs (26.7% vs. 61.3%, p<0.01). Procedural aspects revealed slight differences in occluder size (optimal: 23.7±3.2 vs. suboptimal: 24.5±3.7 mm, p=0.3), need for repositioning (10.3% vs. 17.7%, p=0.25) and procedural duration (48±36 vs. 52±34 min, p=0.3). Of interest, device related thrombi (DRT) occurred less frequently in optimally implanted devices (3.4% vs. 12.9%, p=0.06). Hereby, implantation depth and depth/angle ratio were found to be predictors for DRT in ROC-analysis, respectively (AUC: 0.7, 95% Confidence interval [CI]: 0.56–0.84, p=0.05 and AUC: 0.72, 95% CI: 0.58–0.86, p=0.03). Optimal vs. suboptimal position Conclusion Echocardiographic classification of device-position is warranted to provide comparability and appears to be feasible. Based on the novel classification provided, optimal device-position is achieved in 50% and is found more often with the use of POs. DRT appeared to occur more often in suboptimal device-position.


2014 ◽  
Vol 62 (S 01) ◽  
Author(s):  
W. Reents ◽  
A. Diegeler ◽  
J. Babin-Ebell ◽  
A. Böning ◽  
R.P. Whitlock

2020 ◽  
Vol 12 (1) ◽  
pp. xiii
Author(s):  
Ranjan K. Thakur ◽  
Andrea Natale

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e044695
Author(s):  
Mu Chen ◽  
Qunshan Wang ◽  
Jian Sun ◽  
Peng-Pai Zhang ◽  
Wei Li ◽  
...  

IntroductionIt is the common clinical practice to prescribe indefinite aspirin for patients with non-valvular atrial fibrillation (NVAF) post left atrial appendage occlusion (LAAO). However, aspirin as a primary prevention strategy for cardiovascular diseases has recently been challenged due to increased risk of bleeding. Therefore, aspirin discontinuation after LAAO in atrial fibrillation (ASPIRIN LAAO) trial is designed to assess the uncertainty about the risks and benefits of discontinuing aspirin therapy at 6 months postimplantation with a Watchman LAAO device in NVAF patients.Methods and analysisThe ASPIRIN LAAO study is a prospective, multicentre, randomised, double-blinded, placebo-controlled non-inferiority trial. Patients implanted with a Watchman device within 6 months prior to enrollment and without pre-existing conditions requiring long-term aspirin therapy according to current guidelines are eligible for participating the trial. Subjects will be randomised in a 1:1 allocation ratio to either the Aspirin group (aspirin 100 mg/day) or the control group (placebo) at 6 months postimplantation. A total of 1120 subjects will be enrolled from 12 investigational sites in China. The primary composite endpoint is stroke, systemic embolism, cardiovascular/unexplained death, major bleeding, acute coronary syndrome and coronary or periphery artery disease requiring revascularisation at 24 months. Follow-up visits are scheduled at 6 and 12 months and then every 12 months until 24 months after the last patient recruitment.Ethics and disseminationEthics approval was obtained from the Ethics Committee of Xinhua Hospital, Shanghai, China (reference number XHEC-C-2018-065-5). The protocol is also submitted and approved by the institutional Ethics Committee at each participating centre. Results are expected in 2024 and will be disseminated through peer-reviewed journals and presentations at national and international conferences.Trial registration numberNCT03821883.


2021 ◽  
Vol 14 (16) ◽  
pp. 1852-1853
Author(s):  
Mahdi Veillet-Chowdhury ◽  
Stewart M. Benton ◽  
C. Anwar A. Chahal ◽  
James E. Harvey ◽  
Paul Tolerico ◽  
...  

2018 ◽  
Vol 71 (9) ◽  
pp. 755-756 ◽  
Author(s):  
Ignacio Cruz-González ◽  
Xavier Freixa ◽  
José Antonio Fernández-Díaz ◽  
José Carlos Moreno-Samos ◽  
Victoria Martín-Yuste ◽  
...  

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