Anatomy and Physiologic Roles of the Left Atrial Appendage

Tan, Nicholas; Yasin, Omar; Sugrue, Alan; Sabbagh, Abdallah El; Foley, Thomas A.; Asirvatham, Samuel J.

doi:10.1016/j.iccl.2017.12.001

Cited by 7 publications

(5 citation statements)

References 101 publications

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“…Therefore, when surgically closing the LAA, care must be taken not to involve the LCX. However, since the LAA has multiple morphologies, its position in relation to the surrounding structures varies, and there are many patients in whom the distance between the LMT and the LAA orifice is closer than 10 mm [ 6 ]. Another case of stenosis of the LMT after LAA clipping has been reported, but this was due to the surgeons’ difficulty in obtaining a clear view during laparoscopic surgery [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

RETRACTED ARTICLE: Acute coronary syndrome due to left main coronary trunk compression 2 months after left atrial auricle clipping: a case report

et al. 2023

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Background Left atrial auricle (LAA) clipping is a common method of preventing cardiogenic thromboembolism. However, acute coronary syndrome (ACS) has been reported as a fatal complication of LAA clipping. We describe a case of ACS 2 months after LAA clipping. Case presentation A 33-year-old male with atrial fibrillation was scheduled LAA clipping during aortic valve replacement for congenital aortic bicuspid valve. The surgery went smoothly with no postoperative complications, but he suddenly went into cardiac arrest 2 months later. Emergency coronary angiography and intravascular ultrasonography revealed that compression by the clip of the left main coronary trunk had caused the ACS. Percutaneous coronary intervention with stents was performed, and the clip was removed under general anesthesia. Conclusion Even in the remote timepoint of LAA clipping, compression of the coronary artery by the clip should be differentiated as a cause of ACS.

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Section: Discussionmentioning

confidence: 99%

RETRACTED ARTICLE: Acute coronary syndrome due to left main coronary trunk compression 2 months after left atrial auricle clipping: a case report

et al. 2023

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“…The role of TEE in the sizing of LAA occluders has been studied for many years. Moreover, different LAA occluders have different sizing parameters ( 17 , 21 ). Both 2D-TEE (the maximum orifice diameter) and 3D-TEE (the maximum orifice diameter, area- or perimeter-derived circumferential orifice diameter) have been effectively used for occlusion sizing.…”

Section: Discussionmentioning

confidence: 99%

“…It is not yet known whether the commonly used landmarks (the LCX and the highest point of the Coumadin ridge) for TEE assessment in LAA orifice measurement during LAA occlusion are suitable for LAA clipping devices. Currently, the sizing parameters based on the landmarks among different LAA occluders are quite different ( 17 , 21 ). In our experience, these two procedures (the intracardiac vs .…”

Section: Discussionmentioning

confidence: 99%

Novel sizing role of 3D transesophageal echocardiography in a novel left atrial appendage clip device for patients undergoing video-assisted atrial fibrillation ablation: a cohort study

Duan,

Li,

Zhou

et al. 2024

Quant Imaging Med Surg

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Background Three-dimensional (3D) transesophageal echocardiography (TEE) has been successfully used in the sizing of left atrial appendage (LAA) occlusion devices, but its use has not yet been studied in LAA clip devices. We sought to develop and validate the novel use of 3D-TEE sizing in a novel LAA clip device for atrial fibrillation (AF) patients undergoing video-assisted thoracic surgery (VATS) ablation. Methods Consecutive patients with isolated AF undergoing LAA clipping or excision during VATS ablation were included in the study between June 2021 and September 2022 at Fuwai Hospital. The patients underwent 3D-TEE examinations preoperatively and postoperatively. The VATS length, LAA clip effective length, and LAA excision margin length were recorded. A correlation analysis, intraclass correlation coefficient (ICC) analysis, and Bland-Altman plot analysis were conducted to examine the TEE parameters, VATS length, LAA clip effective length, and LAA excision margin length. Results In total, 26 AF patients undergoing LAA clipping and 15 undergoing LAA excision were included in the study. In the LAA clipping group, in which the Atriclip size served as the control, the 3D-TEE with volumetric measurement (the perimeter-derived maximum orifice diameter) (R=0.938; ICC =0.934; Bland-Altman plot variability, 3.85%) showed the best sizing efficacy for the LAA clip device among the 3D-TEE with multiplanar reformatting sizing (the perimeter-derived maximum orifice diameter) (R=0.808; ICC =0.772; Bland-Altman plot variability, 3.85%), VATS sizing (R=0.851; ICC =0.756; Bland-Altman plot variability, 11.54%), and VATS plus 0.5-cm sizing (R=0.851; ICC =0.775; Bland-Altman plot variability, 11.54%) measurements (all P<0.001). In addition, for the distribution of matched sizing in the LAA clip group, 3D-TEE with volumetric measurement sizing (20/26) had a higher proportion than 3D-TEE with multiplanar reformatting sizing (11/26, P=0.011), VATS sizing (9/26, P=0.002), and VATS plus 0.5-cm sizing (14/26, P=0.08). Using the LAA excision margin length as the control, the mean difference in the LAA diameter was 1.17 cm [95% confidence interval (CI): 0.71–1.62 cm , P<0.001] in the maximum orifice diameter of two-dimensional-TEE, 0.15 cm (95% CI: −0.32 to 0.61 cm , P=0.523) in the perimeter-derived 3D multiplanar reformatting (the maximum orifice diameter), and 0.03 cm (95% CI: −0.47 to 0.53, P=0.901) in the perimeter-derived 3D volumetric (3DV) measurement (the maximum orifice diameter), and the related Pearson correlation coefficients for these modalities were 0.760 (P=0.001), 0.843 (P<0.001), and 0.963 (P<0.001), respectively. Conclusions Our study showed that 3D-TEE might be employed in the sizing of a novel LAA clip device using the VATS approach in patients with AF. The 3DV measurement (the perimeter-derived maximum orifice diameter) was superior to the VATS measurement. These findings might also apply to LAA VATS excision p...

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“…Recently, a meta-analysis comparing Watchman and Amplatzer devices for stroke protection resulted in similar low complication and event rates findings with comparable efficacy and safety results [23]. There are also many other emerging LAA mechanical device technologies in various stages of pre-clinical development [24][25][26][27][28].…”

Section: Discussionmentioning

confidence: 99%

Demonstration of proof-of-concept of StrokeShield system for complete closure and occlusion of the left atrial appendage for non-valvular atrial fibrillation therapy

et al. 2021

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In the US, the most significant morbidity and mortality associated with non-valvular atrial fibrillation (NVAF) is embolic stroke, with 90% of thrombus originating from the left atrial appendage (LAA). Anticoagulation is the preferred treatment for the prevention of stroke in NVAF patients, but clinical studies have demonstrated high levels of non-compliance and increased risk of bleeding or ineligibility for anticoagulation therapy, especially in the elderly population where the incidence of NVAF is highest. Alternatively, stroke may be preventing using clinically approved surgical and catheter-based devices to exclude or occlude the LAA, but these devices continue to be plagued by peri-device leaks and thrombus formation because of residual volume. To overcome these limitations, Cor Habere (Louisville, KY) and the University of Louisville are developing a LAA closure device (StrokeShield) that completely occludes and collapses the LAA to minimize the risk of stroke. The StrokeShield device is a collapsible occluder (nitinol reinforced membrane) that completely covers the LAA orifice with an expandable conical coil anchor that attaches to the myocardium. The device is designed for catheter-based delivery and expands to completely occlude the LAA orifice and collapse the LAA. The primary advantages of the StrokeShield system are a completely sealed LAA (no peri-device flow or residual space) and smooth endothelialized connection to the left atrial wall with minimal risk of cardiac bleeding and tamponade. We tested proof-of-concept of a prototype StrokeShield device in acute (n = 2) and chronic 60-day (n = 2) healthy canine models. Acute results demonstrated that the conical coil securely attached to the myocardium (5N pull-out force) and the Nitinol umbrella fully deployed and covered the LAA ostium. Results from the chronic implants demonstrated long-term feasibility of device placement with no procedural or device-related intra- or post-operative complications, secure placement and correct positioning of the device with no device migration. The device successfully occluded the LAA ostium and collapsed the LAA with no interference with the mitral valve, circumflex coronary artery, or pulmonary veins. Necropsy demonstrated no gross signs of thrombus or end-organ damage and the device was encapsulated in the LAA. Histology demonstrated mature neointima covering the device with expected foreign body inflammatory response. These early positive results will help to guide the iterative design process for the continued development of the StrokeShield system.

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Anatomy and Physiologic Roles of the Left Atrial Appendage

Cited by 7 publications

References 101 publications

RETRACTED ARTICLE: Acute coronary syndrome due to left main coronary trunk compression 2 months after left atrial auricle clipping: a case report

RETRACTED ARTICLE: Acute coronary syndrome due to left main coronary trunk compression 2 months after left atrial auricle clipping: a case report

Novel sizing role of 3D transesophageal echocardiography in a novel left atrial appendage clip device for patients undergoing video-assisted atrial fibrillation ablation: a cohort study

Demonstration of proof-of-concept of StrokeShield system for complete closure and occlusion of the left atrial appendage for non-valvular atrial fibrillation therapy

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