Considerations for Left Atrial Appendage Occlusion During Cardiac Surgery

Sylvester, Christopher B.; Patel, Vivek; Ghanta, Ravi K.; Loor, Gabriel

doi:10.1007/s10557-022-07415-y

Cited by 3 publications

(4 citation statements)

References 50 publications

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“…Over the past decade, left atrial appendage closure using occluder devices, suture loops or excision procedures have emanated as alternatives to prevent and revert the thrombosis process. However, LAA removal or ligation techniques, such as surgical excision and internal suture obliteration, require cardiac arrest, and the use of epicardial clip occlusion or stapled excision can pose challenges related to device navigation and the risk of procedure-related tears along the staple line [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Impact of occluder device configurations in in-silico left atrial hemodynamics for the analysis of device-related thrombus

Albors,

Mill,

Olivares

et al. 2024

Preprint

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Left atrial appendage occlusion devices (LAAO) are a feasible alternative for non-valvular atrial fibrillation (AF) patients at high risk of thromboembolic stroke and contraindication to antithrombotic therapies. However, optimal LAAO device configurations (i.e., size, type, location) remain unstandardized due to the large anatomical variability of the left atrial appendage (LAA) morphology, leading to a 4-6% incidence of device-related thrombus (DRT). In-silico simulations have the potential to assess DRT risk and identify the key factors, such as suboptimal device positioning. This work presents fluid simulation results computed on 20 patient-specific left atrial geometries, analysing different commercially available LAAO occluders, including plug-type and pacifier-type devices. In addition, we explored two distinct device positions: 1) the real post-LAAO intervention configuration derived from follow-up imaging; and 2) one covering the pulmonary ridge if it was not achieved during the implantation (13 out of 20). In total, 33 different configurations were analysed. In-silico indices indicating high risk of DRT (e.g., low blood flow velocities and flow complexity around the device) were combined with particle deposition analysis based on a discrete phase model. The obtained results revealed that covering the pulmonary ridge with the LAAO device may be one of the key factors to prevent DRT. Moreover, disk-based devices exhibited enhanced adaptability to various LAA morphologies and, generally, demonstrated a lower risk of abnormal events after LAAO implantation.

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Section: Introductionmentioning

confidence: 99%

Impact of occluder device configurations in in-silico left atrial hemodynamics for the analysis of device-related thrombus

Albors,

Mill,

Olivares

et al. 2024

Preprint

View full text Add to dashboard Cite

show abstract

“…In addition, patients should have a high risk of bleeding (e.g., high HAS‐BLED score ≥3) or oral anticoagulant(OAC) intolerance(including previous bleeding, risk of falls, uncontrolled hypertension, kidney or liver failure, alcohol intake, concurrent use of antiplatelet or non steroidal drugs, high‐risk occupations, poor compliance, unstable international standardized ratios, OAC allergies, and drug interactions, among other factors) 4 . Research has shown that LAAC surgery is associated with a reduced incidence of cardiovascular events during hospitalization, and can also improve patient prognosis in long‐term follow‐up 5,6 . In the past 20 years, among non‐valvular atrial fibrillation patients with increased risk of stroke, LAAC has become a safe and effective alternative to oral anticoagulants for stroke prevention 7 .…”

Section: Introductionmentioning

confidence: 99%

“… 4 Research has shown that LAAC surgery is associated with a reduced incidence of cardiovascular events during hospitalization, and can also improve patient prognosis in long‐term follow‐up. 5 , 6 In the past 20 years, among non‐valvular atrial fibrillation patients with increased risk of stroke, LAAC has become a safe and effective alternative to oral anticoagulants for stroke prevention. 7 However, the drawbacks of left atrial appendage occlusion cannot be ignored.…”

Section: Introductionmentioning

confidence: 99%

Displacement of occluder after left atrial appendage closure: A case report

Lin,

Mao

2024

Clinical Case Reports

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Key Clinical MessageAtrial fibrillation is closely associated with thrombotic events. In non‐valvular atrial fibrillation, 90% of thrombi are formed by the left atrial appendage. Left atrial appendage occlusion (LAAC) can effectively prevent the detachment of left atrial appendage thrombus during atrial fibrillation, thereby reducing the risk of long‐term disability or death caused by thromboembolic events. However, the identification and management of complications in LAAC are also very important.AbstractThe efficacy and safety of left atrial appendage occlusion (LAAC) in preventing non‐valvular atrial fibrillation stroke have been confirmed by multiple randomized controlled and registered studies, and have been recommended by several guidelines for stroke prevention in patients with atrial fibrillation at high‐risk of stroke. We reported an 80‐year‐old male patient with persistent atrial fibrillation. The patient underwent left atrial appendage closure surgery due to high risk of embolism and bleeding. On the second day after surgery, echocardiography showed displacement of the left atrial appendage occluder. Immediately perform removal of left atrial appendage occlude and left atrial appendage occlusion on the same day, and the patient was discharged on the fifth day after surgery without any special circumstances. This case demonstrates the feasibility and important clinical significance of using interventional surgery to remove the left atrial appendage occluder after displacement in clinical practice.

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“…AF is associated with an increased risk of thromboembolism and stroke, requiring anticoagulation. Despite progress and development in anticoagulation strategies, the high risk of bleeding complications and strict medication adherence make treatment more complex.In the past few decades, left atrial appendage has become a promising therapeutic target,which can prevent thromboembolic events while reducing the problem of bleeding complications (2,3).Research has shown that left atrial appendage occlusion (LAAO) surgery is associated with a reduced incidence of cardiovascular events during hospitalization, and can also improve patient prognosis in long-term followup (4,5). In the past 20 years, among non valvular atrial fibrillation patients with increased risk of stroke, LAAO has become a safe and effective alternative to oral anticoagulants for stroke prevention (6).…”

mentioning

confidence: 99%

Displacement of occluder after left atrial appendage closure（LAAC）:A case report

Mao,

Lin

2024

Preprint

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Considerations for Left Atrial Appendage Occlusion During Cardiac Surgery

Cited by 3 publications

References 50 publications

Impact of occluder device configurations in in-silico left atrial hemodynamics for the analysis of device-related thrombus

Impact of occluder device configurations in in-silico left atrial hemodynamics for the analysis of device-related thrombus

Displacement of occluder after left atrial appendage closure: A case report

Displacement of occluder after left atrial appendage closure（LAAC）:A case report

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