Left atrial appendage and atrial septal occlusion in elderly patients with atrial septal defect and atrial fibrillation

Abstract Background: One-stop occlusion, which is defined as the combination of atrial septal defect [ASD] or patent foramen ovale [PFO] occlusion and left atrial appendage [LAA] closure, in patients with ASD/PFO and atrial fibrillation (AF) has not yet been investigated systematically. This study aimed to evaluate the safety and efficacy of one-stop occlusion in the treatment of adult patients with ASD/PFO and AF.Methods: Inpatients with AF and ASD/PFO were recruited between August 2014 and April 2019. Preoperatively, transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) were conducted to identify the ASD/PFO size and margin, presence of thrombus in the LAA, and LAA orifice width and depth at 0°, 45°, 90°, and 135°. After confirmation of the indications of LAA closure (LAAC) and ASD/PFO occlusion, the procedures were performed simultaneously under general anesthesia. Oral anticoagulants were administered for 45-60 days, followed with regular evaluation of TTE and TEE.Results: Forty-nine patients (age, 65.6±9.6 years) were recruited in this study, including 24 patients with ASD and 25 patients with PFO. They were treated with LAAC and ASD/PFO occlusion successfully. The mean ASD size and mean diameter of the ASD occluders were 14.2±7.7 and 25.4±8.5 mm, respectively. The mean PFO size was 3.5±0.4 mm. The mean maximal LAA orifice width and depth were 20.5±3.4 and 28.3±3.6 mm, respectively. All patients were implanted with a Watchman device (diameter, 27.1±2.9 mm). Postoperatively, all patients took anticoagulants orally for 45-60 days, and their mean postoperative follow-up duration was 29.0±12.1 months. Postoperative TEE showed that all had normal positioning of the LAA and ASD/PFO occluders. At 45-60 days after operation, TEE showed that the LAA and ASD/PFO occluder were in the normal position; however, two patients who took warfarin and novel oral anticoagulants, respectively, have developed occluder thrombosis. After adjusted anticoagulant therapy, TEE showed that the thrombus disappeared at 6 months after operation.Conclusion: One-stop occlusion is safe and effective for the treatment of adult patients with ASD/PFO and AF. It is also feasible to administer warfarin or novel oral anticoagulants after operation.

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“One-stop shop”: Safety and efficacy of combining atrial septal defect occlusion and left atrial appendage closure for patients with atrial septal defect and atrial fibrillation.

10.21203/rs.3.rs-25542/v1 ◽

2020 ◽

Author(s):

zhang zhihui ◽

yao qing ◽

Huang haiyun ◽

zhu ping ◽

xu xiang ◽

...

Keyword(s):

Atrial Fibrillation ◽

Atrial Septal Defect ◽

Left Atrial ◽

Septal Defect ◽

Left Atrial Appendage ◽

Oral Anticoagulants ◽

Safety And Efficacy ◽

One Stop ◽

The Mean ◽

Laa Closure

Abstract Background: One-stop occlusion (combination of atrial septal defect [ASD] or patent foramen ovale [PFO] occlusion and left atrial appendage [LAA] closure) in patients with ASD/PFO and atrial fibrillation (AF) has not yet been investigated systematically. This study aimed to evaluate the safety and efficacy of one-stop occlusion in the treatment of adult patients with ASD/PFO and AF.Methods: We recruited inpatients with AF and ASD/PFO between August 2014 and April 2019. Preoperatively, they underwent transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) to determine the ASD/PFO size and margin, presence of thrombus in the LAA, and LAA orifice width and depth at 0°, 45°, 90°, and 135°. After confirmation of the indications of LAA closure (LAAC) and ASD/PFO occlusion, the procedures were performed simultaneously under general anesthesia. Oral anticoagulants were administered for 6 months, and the TTE and TEE were evaluated regularly.Results: Forty-nine patients (age, 65.6±9.6 years) were recruited in this study, including 24 patients with ASD and 25 patients with PFO. They underwent simultaneous LAAC and ASD/PFO occlusion successfully. The mean ASD size and mean diameter of the plug devices for ASD occlusion were 14.2±7.7 and 25.4±8.5 mm, respectively. The mean PFO size was 3.5±0.4 mm. The mean maximal LAA orifice width and depth were 20.5±3.4 and 28.3±3.6 mm, respectively. All patients were implanted with a Watchman device (diameter, 27.1±2.9 mm). Postoperatively, all patients took oral anticoagulants for 6 months, and their mean postoperative follow-up duration was 29.0±12.1 months. Postoperative TEE showed that all had normal positioning of the LAA and ASD/PFO plug devices. At 45-60 days after operation, TEE showed that the LAA and ASD/PFO occluder were in the normal position; however, two patients developed occluder thrombosis (warfarin and novel oral anticoagulants were used, respectively). The anticoagulant therapy was adjusted, and TEE showed that the thrombus disappeared at 6 months after operation.Conclusion: One-stop occlusion is safe and effective for the treatment of adult patients with ASD/PFO and AF. It is also feasible to administer warfarin or novel oral anticoagulants after operation.

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“One-stop shop”: Safety and efficacy of combining atrial septal defect occlusion and left atrial appendage closure for patients with atrial septal defect and atrial fibrillation.

10.21203/rs.3.rs-25542/v3 ◽

2020 ◽

Author(s):

zhang zhihui ◽

yao qing ◽

Huang haiyun ◽

zhu ping ◽

xu xiang ◽

...

Keyword(s):

Atrial Fibrillation ◽

Atrial Septal Defect ◽

Left Atrial ◽

Septal Defect ◽

Left Atrial Appendage ◽

Oral Anticoagulants ◽

Safety And Efficacy ◽

One Stop ◽

The Mean ◽

Laa Closure

Abstract Background: One-stop occlusion, which is defined as the combination of atrial septal defect [ASD] or patent foramen ovale [PFO] occlusion and left atrial appendage [LAA] closure, in patients with ASD/PFO and atrial fibrillation (AF) has not yet been investigated systematically. This study aimed to evaluate the safety and efficacy of one-stop occlusion in the treatment of adult patients with ASD/PFO and AF.Methods: Inpatients with AF and ASD/PFO were recruited between August 2014 and April 2019. Preoperatively, transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) were conducted to identify the ASD/PFO size and margin, presence of thrombus in the LAA, and LAA orifice width and depth at 0°, 45°, 90°, and 135°. After confirmation of the indications of LAA closure (LAAC) and ASD/PFO occlusion, the procedures were performed simultaneously under general anesthesia. Oral anticoagulants were administered for 45-60 days, followed with regular evaluation of TTE and TEE.Results: Forty-nine patients (age, 65.6±9.6 years) were recruited in this study, including 24 patients with ASD and 25 patients with PFO. They were treated with LAAC and ASD/PFO occlusion successfully. The mean ASD size and mean diameter of the ASD occluders were 14.2±7.7 and 25.4±8.5 mm, respectively. The mean PFO size was 3.5±0.4 mm. The mean maximal LAA orifice width and depth were 20.5±3.4 and 28.3±3.6 mm, respectively. All patients were implanted with a Watchman device (diameter, 27.1±2.9 mm). Postoperatively, all patients took anticoagulants orally for 45-60 days, and their mean postoperative follow-up duration was 29.0±12.1 months. Postoperative TEE showed that all had normal positioning of the LAA and ASD/PFO occluders. At 45-60 days after operation, TEE showed that the LAA and ASD/PFO occluder were in the normal position; however, two patients who took warfarin and novel oral anticoagulants, respectively, have developed occluder thrombosis. After adjusted anticoagulant therapy, TEE showed that the thrombus disappeared at 6 months after operation.Conclusion: One-stop occlusion is safe and effective for the treatment of adult patients with ASD/PFO and AF. It is also feasible to administer warfarin or novel oral anticoagulants after operation.

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“One-stop shop”: safety and efficacy of combining atrial septal defect occlusion and left atrial appendage closure for patients with atrial septal defect and atrial fibrillation

BMC Cardiovascular Disorders ◽

10.1186/s12872-020-01708-6 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Zhi-hui Zhang ◽

Qing Yao ◽

Hai-yun Huang ◽

Ping Zhu ◽

Xiang Xu ◽

...

Keyword(s):

Atrial Fibrillation ◽

Atrial Septal Defect ◽

Left Atrial ◽

Septal Defect ◽

Left Atrial Appendage ◽

Oral Anticoagulants ◽

Safety And Efficacy ◽

One Stop ◽

The Mean ◽

Laa Closure

Abstract Background One-stop occlusion, which is defined as the combination of atrial septal defect [ASD] or patent foramen ovale [PFO] occlusion and left atrial appendage [LAA] closure, in patients with ASD/PFO and atrial fibrillation (AF) has not yet been investigated systematically. This study aimed to evaluate the safety and efficacy of one-stop occlusion in the treatment of adult patients with ASD/PFO and AF. Methods Inpatients with AF and ASD/PFO were recruited between August 2014 and April 2019. Preoperatively, transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) were conducted to identify the ASD/PFO size and margin, presence of thrombus in the LAA, and LAA orifice width and depth at 0°, 45°, 90°, and 135°. After confirmation of the indications of LAA closure (LAAC) and ASD/PFO occlusion, the procedures were performed simultaneously under general anesthesia. Oral anticoagulants were administered for 45–60 days, followed with regular evaluation of TTE and TEE. Results Forty-nine patients (age, 65.6 ± 9.6 years) were recruited in this study, including 24 patients with ASD and 25 patients with PFO. They were treated with LAAC and ASD/PFO occlusion successfully. The mean ASD size and mean diameter of the ASD occluders were 14.2 ± 7.7 and 25.4 ± 8.5 mm, respectively. The mean PFO size was 3.5 ± 0.4 mm. The mean maximal LAA orifice width and depth were 20.5 ± 3.4 and 28.3 ± 3.6 mm, respectively. All patients were implanted with a Watchman device (diameter, 27.1 ± 2.9 mm). Postoperatively, all patients took anticoagulants orally for 45–60 days, and their mean postoperative follow-up duration was 29.0 ± 12.1 months. Postoperative TEE showed that all had normal positioning of the LAA and ASD/PFO occluders. At 45–60 days after operation, TEE showed that the LAA and ASD/PFO occluder were in the normal position; however, two patients who took warfarin and novel oral anticoagulants, respectively, have developed occluder thrombosis. After adjusted anticoagulant therapy, TEE showed that the thrombus disappeared at 6 months after operation. Conclusion One-stop occlusion is safe and effective for the treatment of adult patients with ASD/PFO and AF. It is also feasible to administer warfarin or novel oral anticoagulants after operation.

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