Anatomic Considerations for Epicardial and Endocardial Left Atrial Appendage Closure

Voskoboinik, Aleksandr; Lee, Randall J.

doi:10.1016/j.ccep.2019.11.001

Cited by 5 publications

(10 citation statements)

References 17 publications

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“…11 Morphology assessment is valuable as certain anatomic features are prohibitive for percutaneous endocardial closure such as shallow LAA ostia followed by sharp bends or early bifurcations, and close proximity to surrounding structures such as the left upper pulmonary vein and mitral annulus when utilizing lobe and disc designs. 12 Notably, 3 cases required intraoperative TEE to exclude LAA thrombus due to low flow or distal filling defect on preoperative CMR.…”

Section: Discussionmentioning

confidence: 99%

“…Prior literature has demonstrated there can be overlap between morphologies when the LAA is viewed from different angles or planes on TEE, and CMR remains the gold standard for cardiac structure evaluation with excellent accuracy and reproducibility 11 . Morphology assessment is valuable as certain anatomic features are prohibitive for percutaneous endocardial closure such as shallow LAA ostia followed by sharp bends or early bifurcations, and close proximity to surrounding structures such as the left upper pulmonary vein and mitral annulus when utilizing lobe and disc designs 12 …”

Section: Discussionmentioning

confidence: 99%

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Cardiac magnetic resonance imaging for left atrial appendage closure planning

Cao

Pieper

Tong

et al. 2023

Pacing Clinical Electrophis

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Background Transesophageal echocardiography (TEE) and cardiac computed tomography angiography (CCTA) are currently utilized for left atrial appendage closure (LAAC) planning. During the recent global iodine contrast media shortage in 2022, cardiac magnetic resonance imaging (CMR) was utilized for the first time for LAAC planning. This study sought to assess the utility of CMR versus TEE for LAAC planning. Methods This single center retrospective study consisted of all patients who underwent preoperative CMR for LAAC with Watchman FLX or Amplatzer Amulet. Key measures were accuracy of LAA thrombus exclusion, ostial diameter, depth, lobe count, morphology, accuracy of predicted device size, and devices deployed per case. Bland‐Altman Analysis was used to compare CMR versus TEE measurements of LAA ostial diameter and depth. Results 25 patients underwent preoperative CMR for LAAC planning. A total of 24 (96%) cases were successfully completed with 1.2 ± 0.5 devices deployed per case. Among the 18 patients who underwent intraoperative TEE, there was no significant difference between CMR versus TEE in LAA thrombus exclusion (CMR 83% vs. TEE 100% cases, p = .229), lobe count (CMR 1.7 ± 0.8 vs. TEE 1.4 ± 0.6, p = .177), morphology (p = .422), and accuracy of predicted device size (CMR 67% vs. TEE 72% cases, p = 1.000). When comparing the difference between CMR and TEE measurements, Bland‐Altman analysis demonstrated no significant difference in LAA ostial diameter (CMR‐TEE bias 0.7 mm, 95% CI [−1.1, 2.4], p = .420), but LAA depth was significantly larger with CMR versus TEE (CMR‐TEE bias 7.4 mm, 95% CI [1.6, 13.2], p = .015). Conclusions CMR is a promising alternative for LAAC planning in cases where TEE or CCTA are contraindicated or unavailable.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Cardiac magnetic resonance imaging for left atrial appendage closure planning

Cao

Pieper

Tong

et al. 2023

Pacing Clinical Electrophis

View full text Add to dashboard Cite

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“…The recent acceleration of percutaneous endocardial LAAO device implantation has provided an enhancement to the availability of echocardiographic and computed tomography imaging of the LAA to help guide ideal LAAO therapy and predict failures. [7][8][9] Common anatomic failures of both endocardial percutaneous therapy and single-layer or purse-string surgical therapy are associated with incomplete occlusion of the orifice and neck. This may lead to residual leak into the LAA, or device-related thrombosis or embolization.…”

Section: Pathoanatomic Considerationsmentioning

confidence: 99%

“…If patients are not carefully selected by appropriate anatomy, these devices can be maldeployed, resulting in prothrombotic foreign body elements jutting into the fibrillating left atrium, incomplete occlusion of the LAA neck, or complete embolization, often requiring surgical therapy to correct. [9][10][11][12] Transesophageal echocardiography may assist in the identification of the orifice and neck, or if clot is present, but the precise morphology of the body may be best identified by computed tomography or direct visual inspection at the time of surgery. The 3 most commonly accepted and surgically performed LAAO techniques involve 2 epicardial and 1 endocardial approach.…”

Section: Technical Considerationsmentioning

confidence: 99%

Contemporary left atrial appendage management during adult cardiac surgery

Badhwar

Rankin

Lee

et al. 2023

The Journal of Thoracic and Cardiovascular Surgery

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“…The LAA is a finger‐like extension of the left atrium, embryologically derived from the primordial pulmonary veins and primitive left atrium 14 . It usually arises off the anterolateral wall of the LA and is directed antero superiorly with its inferior surface overlying the left ventricle.…”

Section: Anatomical and Physiological Considerationsmentioning

confidence: 99%

Current practice and future prospects in left atrial appendage occlusion

Narasimhan

Aedma

Bhatia

et al. 2021

Pacing Clinical Electrophis

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The thromboembolic complications of Atrial fibrillation (AF) remain a major problem in contemporary clinical practice. Despite advances and developments in anticoagulation strategies, therapy is complicated by the high risk of bleeding complications and need for meticulous medication compliance. Over the past few decades, the left atrial appendage has emerged as a promising therapeutic target to prevent thromboembolic events while mitigating bleeding complications and compliance issues. Emerging data indicates that it is a safe, effective and feasible alternative to systemic anticoagulation in patients with non‐valvular AF. A number of devices have been developed for endocardial or epicardial based isolation of the left atrial appendage. Increasing experience has improved overall procedural safety and ease while simultaneously reducing device related complication rates. Furthermore, increasing recognition of the non‐mechanical advantages of this procedure has led to further interest in its utility for further indications beyond the prevention of thromboembolic complications. In this review, we present a comprehensive overview of the evolution of left atrial appendage occlusion, commercially available devices and the role of this modality in the current management of AF. We also provide a brief outline of the landmark trials supporting this approach as well as the ongoing research and future prospects of left atrial appendage occlusion

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Anatomic Considerations for Epicardial and Endocardial Left Atrial Appendage Closure

Cited by 5 publications

References 17 publications

Cardiac magnetic resonance imaging for left atrial appendage closure planning

Cardiac magnetic resonance imaging for left atrial appendage closure planning

Contemporary left atrial appendage management during adult cardiac surgery

Current practice and future prospects in left atrial appendage occlusion

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