Left Atrial Appendage Occlusion

Alkhouli, Mohamad; Ellis, Christopher R.; Daniels, Matthew J.; Coylewright, Megan; Nielsen‐Kudsk, Jens Erik; Holmes, David R.

doi:10.1016/j.jacadv.2022.100136

Cited by 33 publications

(35 citation statements)

References 82 publications

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“…Many inoperable patients are now eligible for the correction of structural cardiac defects with benefits in terms of functional capacity and quality of life. At the forefront of innovation are procedures such as insertion of left atrial appendage occlusion (LAAO) devices, transcatheter aortic valve implantation (TAVI) as well as advancements in imaging techniques, such as multidetector computed tomography (MDCT) and three-dimensional (3D) reconstruction (1)(2)(3)(4). In this editorial, we will discuss some of the latest advancements and novel methodologies in structural intervention by summarising the main findings and key aspects of a collection of articles published in Frontiers in Cardiovascular Medicine under this exciting research topic.…”

Section: Editorial On the Research Topic Novel Methodologies In Struc...mentioning

confidence: 99%

Editorial: Novel methodologies in structural interventional cardiology: Case reports

O’Sullivan

O’Sullivan²,

Maeder

2023

Front. Cardiovasc. Med.

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Section: Editorial On the Research Topic Novel Methodologies In Struc...mentioning

confidence: 99%

Editorial: Novel methodologies in structural interventional cardiology: Case reports

O’Sullivan

O’Sullivan²,

Maeder

2023

Front. Cardiovasc. Med.

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“…Sub-optimal selection of device characteristics can lead to undesired events at follow-up, such as device embolization, peri-device leaks, or device-related thrombus (DRT). A recent meta-analysis by Alkhouli et al (2022) [15] reports an incidence of DRT in 4-6% of the cases. The causes leading to DRT may potentially be attributed to various factors, including post-procedural complications (e.g., incomplete device endothelialization), demographic and clinical characteristics (e.g., comorbidities, age-dependency), deep-device-LAA implantation uncovering the pulmonary vein ridge (i.e., > 10 mm distance from the Left Superior Pulmonary Vein (LSPV) ridge) or device type (i.e., pacifier-and plug-type devices) [15][16][17].…”

Section: Introductionmentioning

confidence: 99%

“…A recent meta-analysis by Alkhouli et al (2022) [15] reports an incidence of DRT in 4-6% of the cases. The causes leading to DRT may potentially be attributed to various factors, including post-procedural complications (e.g., incomplete device endothelialization), demographic and clinical characteristics (e.g., comorbidities, age-dependency), deep-device-LAA implantation uncovering the pulmonary vein ridge (i.e., > 10 mm distance from the Left Superior Pulmonary Vein (LSPV) ridge) or device type (i.e., pacifier-and plug-type devices) [15][16][17]. While the clinical routine presents the benefits of anticoagulation for clot prophylaxis, there is not a consensus on the ideal drug therapy (i.e., drug choice, dosage, timings) following device implantation, being DRT management still a clinical unsolved problem.…”

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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“…Percutaneous left atrial appendage occlusion (LAAO) has emerged as an alternative therapy to oral anticoagulation (OAC) in high‐risk atrial fibrillation patients who are not suitable for long‐term anticoagulation 1 . Since the inception of LAAO in the early 2000s, technical and clinical advances have led to substantial improvement in its safety with major adverse events currently occurring in 2%–3% of patients in contemporary US practice 2–5 …”

Section: Introductionmentioning

confidence: 99%

Utilization and outcomes of protamine after percutaneous left atrial appendage occlusion

Ponce

Shaer

Samimi

et al. 2023

Cathet Cardio Intervent

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Objectives The aim of this study was to describe the use pattern and outcomes of protamine administration for heparin reversal among sites performing percutaneous left atrial appendage occlusion (LAAO). Methods We identified 45,135 patients who underwent LAAO at 243 hospitals participating in Vizient® Clinical Database between January 1, 2016 and December 31, 2021. Patients were stratified according to protamine administration after the procedure. Outcomes of interest included vascular complications, major bleeding, ischemic events, and same‐day discharge. Results A total of 40,278 patients were included in the propensity‐matched comparison, of whom 50% received protamine after the LAAO procedure. The use of protamine varied across hospitals, with 88 hospitals (36.2%) using protamine in >75% of cases and 32 hospitals (13.1%) not using protamine at all. Major bleeding occurred less frequently in the protamine group compared with the control group (2.4% vs. 2.8%, p = 0.03). Major vascular complications and pericardial tamponade were rare but slightly higher in the protamine group (0.8% vs. 0.6%, p = 0.04) and (1.0% vs. 0.8%, p = 0.01), respectively. There were no differences in the rates of ischemic or hemorrhagic stroke, all‐cause mortality, or the rate of any major adverse event between the two groups. Same‐day discharge was more frequent in the protamine group (12.3% vs 9.4%, p ≤ 0.001). Conclusions Protamine is used in approximately 50% of LAAO procedures and is associated with lower bleeding events and higher rates of same‐day discharge. The higher vascular complication and tamponade is likely due to its ad‐hoc use as a reversal agent in these patients.

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Left Atrial Appendage Occlusion

Cited by 33 publications

References 82 publications

Editorial: Novel methodologies in structural interventional cardiology: Case reports

Editorial: Novel methodologies in structural interventional cardiology: Case reports

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

Utilization and outcomes of protamine after percutaneous left atrial appendage occlusion

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