scholarly journals Does left atrial appendage occlusion influence left atrial hemodynamics? Pilot results of invasive intra-cardiac measurements

2021 ◽  
Author(s):  
Samuel Heuts ◽  
John Heijmans ◽  
Mark La Meir ◽  
Bart Maesen
Keyword(s):  
Pilot Study ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Systemic Arterial Pressure ◽  
Left Ventricular ◽  
Hemodynamic Effect ◽  
Atrial Appendage ◽  
Central Venous ◽  
Left Atrial Appendage Occlusion ◽  
Laa Closure

Introduction Although left atrial appendage (LAA) obliteration is the cornerstone of stroke prevention in surgical treatment of atrial fibrillation (AF), little is known about its direct impact on hemodynamics. In the current pilot study, we evaluated the hemodynamic effect of LAA closure by clipping in patients undergoing hybrid AF ablation. Methods Seven patients with paroxysmal or persistent AF were included. Hemodynamic and intracardiac pressure measurements such as systemic, pulmonary artery (PA), central venous and LA pressure, cardiac output and indexed left ventricular stroke volume (LVSVi) were measured directly before (T0) and after (T1), and 10 minutes after (T2) LAA closure. Results Of the 7 patients (median 66 yrs), 5 were in AF at the time of incision. There were no differences between T0 and T1, T1 and T2 and T0 and T2 for LA pressure, mean PA pressure, LVSVi and other hemodynamic parameters such as central venous oxygenation and pressure, or systemic arterial pressure. Conclusion In this pilot study, the direct hemodynamic effect of LAA closure is evaluated for the first time. Clipping of the LAA is safe and does not directly affect hemodynamic and intracardiac pressures.

scholarly journals Game changer? A sporting indication to implant a left atrial appendage closure device in a rugby player with atrial fibrillation: a case report

2020 ◽  
Vol 4 (1) ◽  
pp. 1-5
Author(s):  
Andre Briosa e Gala ◽  
Andrew Cox ◽  
Michael Pope ◽  
Timothy Betts
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Left Ventricular ◽  
Atrial Appendage ◽  
Rugby Player ◽  
Management Options ◽  
Left Atrial Appendage Occlusion ◽  
Occlusion Device

Abstract Background Caring for athletes with cardiac disease requires an approach that caters to the specific needs of the athlete. Case summary A 27-year-old professional rugby player was admitted with decompensated heart failure and atrial fibrillation (AF). Transthoracic echocardiogram showed features in keeping with a dilated cardiomyopathy with severe left ventricular (LV) systolic impairment. He made good progress on evidence-based heart failure medication and his LV systolic function returned to normal. He failed to maintain sinus rhythm with cardioversion and remained in persistent AF. He then suffered a transient ischaemic attack despite appropriate anticoagulation. At 1-year follow-up, he was asymptomatic and against medical advice continued to play competitive rugby whilst taking rivaroxaban. He subsequently underwent implantation with a percutaneous left atrial appendage occlusion device, allowing him to discontinue anticoagulation, reduce his bleeding risk and resume his career, whilst simultaneously lowering the thromboembolic risk. Discussion Counselling should include different management options aimed at minimizing the risks to athletes if they to return to competitive sports. Left atrial appendage occlusion devices are a suitable AF-related stroke prevention strategy in athletes competing in full-contact sports.

scholarly journals A Pilot Study for Left Atrial Appendage Occlusion Guided by 3-Dimensional Rotational Angiography Alone

2018 ◽  
Vol 11 (2) ◽  
pp. 223-224 ◽  
Author(s):  
Tom De Potter ◽  
Sofia Chatzikyriakou ◽  
Etel Silva ◽  
Guy Van Camp ◽  
Martin Penicka
Keyword(s):  
Pilot Study ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Atrial Appendage ◽  
Rotational Angiography ◽  
3 Dimensional ◽  
Left Atrial Appendage Occlusion

Totally Endoscopic Robotic Left Atrial Appendage Closure Demonstrates High Success Rate

2017 ◽  
Vol 12 (1) ◽  
pp. 46-49 ◽  
Author(s):  
Alison F. Ward ◽  
Robert M. Applebaum ◽  
Nana Toyoda ◽  
Ans Fakiha ◽  
Peter J. Neuburger ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Suture Line ◽  
Atrial Appendage ◽  
Success Rates ◽  
Left Atrial Appendage Occlusion ◽  
Mitral Repair ◽  
Incomplete Closure ◽  
Laa Closure

Objective In patients with atrial fibrillation, 90% of embolic strokes originate from the left atrial appendage (LAA). Successful exclusion of the LAA is associated with a lower stroke rate in patients with atrial fibrillation. Surgical oversewing of the LAA is often incomplete when evaluated with transesophageal echocardiogram (TEE). External closure techniques of suturing and stapling have also demonstrated high failure rates with persistent flow and large stumps. We hypothesized that the precise visualization of a robotic LAA closure (RLAAC) would result in superior closure rates. Methods Before robotic mitral repair, patients underwent RLAAC; the base of the LAA was oversewn using a running 4–0 polytetrafluoroethylene suture in two layers. Postoperatively, the LAA was interrogated in multiple TEE views. Incomplete closure was defined as any flow across the LAA suture line or a residual stump of greater than 1 cm. Results Seventy-nine consecutive patients underwent RLAAC; no injuries occurred. On postrepair TEE, 73 of 79 patients had LAAs visualized well enough to thoroughly evaluate. Successful ligation was confirmed in 64 (87.7%) of 73 patients. Seven patients (9.6%) had small jet flow into the LAA; no residual stumps were noted. Two patients (2.7%) had undetermined flow. Conclusions We have demonstrated excellent success with RLAAC; we postulate that this may be due to improved intracardiac visualization. Robotic LAA closure was more successful (87.7%) than previously reported results from the Left Atrial Appendage Occlusion Study for suture exclusion (45.5%) and staple closure (72.7%). With success rates equivalent to transcatheter device closures, RLAAC should be considered for robotic mitral valve surgical patients.

Rationale and trial design of the Left Atrial Appendage Occlusion Study (LAAOS III)

2014 ◽  
Vol 62 (S 01) ◽  
Author(s):  
W. Reents ◽  
A. Diegeler ◽  
J. Babin-Ebell ◽  
A. Böning ◽  
R.P. Whitlock
Keyword(s):  
Left Atrial ◽  
Trial Design ◽  
Left Atrial Appendage ◽  
Atrial Appendage ◽  
Left Atrial Appendage Occlusion

scholarly journals Left Atrial Appendage Occlusion

2020 ◽  
Vol 12 (1) ◽  
pp. xiii
Author(s):  
Ranjan K. Thakur ◽  
Andrea Natale
Keyword(s):  
Left Atrial ◽  
Left Atrial Appendage ◽  
Atrial Appendage ◽  
Left Atrial Appendage Occlusion
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