Percutaneous left atrial appendage closure using the LAmbre device in patients with atrial fibrillation and left atrial appendage thrombus

Abstract

BackgroundLeft atrial appendage closure (LAAC) is considered a valid alternative for the prevention of thromboembolic stroke in patients with persistent left atrial appendage thrombus (LAAT) despite adequate anticoagulation. However, the data on LAAC using the LAmbre device for patients with LAAT is limited. This study was performed to explore efficacy and safety as well as to share the experience of the modified LAAC procedure with the LAmbre device.Materials and methodsA total of 7 patients with persistent LAAT despite adequate anticoagulation underwent modified LAAC with the LAmbre device between November 2019 and April 2022. Transesophageal echocardiography was performed 3 months postoperatively to detect device-related thrombosis and peridevice leak. The patients’ clinical events were evaluated during the perioperative and follow-up periods.ResultsThe median age, CHA2DS2-VASc score, and HAS-BLED score of all patients were 71 [53–73], 3 [2–4], and 2 [2–3], respectively. In the procedure, a cerebral protection system was used in two patients. LAAC with the LAmbre device was successfully performed in all patients without perioperative events. During the median follow-up of 383 [325–865] days, postoperative transesophageal echocardiography was performed in six (85.7%) patients. Device-related thrombosis was detected in one (16.7%) patient, and no significant peridevice leak was observed. No thromboembolic event or bleeding event occurred in any patients.ConclusionLAAC with the LAmbre device is effective and safe when performed by experienced operators in highly selected patients with LAAT after adequate anticoagulation.

Left atrial appendage thrombus formation despite oral anticoagulation: what can we do when there is nothing to offer?

“…The most frequently found arrhythmia was persistent AF (18). In our series, the average CHADS-VASC2 score (the most used in the assessment of embolic risk in this population) was 1.4, suggesting that the real risk could be underestimated using this score alone (29)(30)(31), in other series the average was 3 (18). We believe that the evaluation of left atrial size, presence of spontaneous contrast, LAA mechanic dysfunction, evaluated by low velocity in the ostium, morphologymultilobed LAA or cauliflower were associated with a higher incidence of TE events -(32 -35) could contribute to personalize the embolic risk in addition to the CHADS-VASc2 Score.…”

Overcoming barriers for left atrial appendage thrombus: a systematic review of left atrial appendage closure

“…Turned the Swartz sheath clockwise to facilitate the advancement of the guidewire into the left superior pulmonary vein. Then, replaced the Swartz sheath with a delivery sheath and then delivered the pigtail catheter in the left superior pulmonary vein and dropped the pigtail catheter to the LAA ostium by slowly pulling the sheath and catheter back [ 13 ] Marroquin 2022 Watchman = 1 Watchman FLX = 4 ACP = 3 Amulet Amplatzer = 41 Lambre = 4 N/A N/A 18 53 TEE Standard deployment techniques and no-touch technique (involves avoiding guidewire or catheter manipulation within the LAA by loading the closure device with the delivery sheath in the left superior pulmonary vein) [ 19 ] Beneduce 2019 Watchman FLX = 1 N/A N/A 1 1 3D TEE and fluoroscopy No-touch technique. After transseptal puncture, the delivery sheath was pulled back from the left upper pulmonary vein over a stiff guidewire.…”

“…The effectiveness and safety of LAAC in patients with LAAT have not been validated. However, recent studies have revealed that LAAC can effectively prevent stroke events in patients with LAAT, with minimal procedural complications [ 12 , 13 ]. These findings suggest that LAAT may not be an absolute contraindication for LAAC.…”

TriGuard Embolic Protection Device in percutaneous cardiac interventions with intracavitary cardiac thrombosis: A case series

“…This device incorporates a delivery sheath that does not extend to the distal LAA, thereby reducing the likelihood of embolism. 11,12 In our setting, indication for LAA closure was on DOAC-recurrent stroke for patient number-1, whereas was an ultima ratio treatment option for the other patients. Our dates are consistent with an acute feasibility and safety of this procedure, without affecting the efficacy over the mid-term.…”

“…A novel device the LAmbre as a two‐part‐device could potentially render it an optimal choice for LAAC in patients with thrombosis. This device incorporates a delivery sheath that does not extend to the distal LAA, thereby reducing the likelihood of embolism 11,12 …”