Percutaneous left atrial appendage closure with complex anatomy by using the staged ‘kissing-Watchman’ technology with double devices

Jiang, Liang; Duenninger, Erich; Muenzel, Manuela; Xue, Xiaonan; Fazakas, Ádám; Keil, Thorsten; Yu, Jianghong

doi:10.1016/j.ijcard.2018.05.007

Cited by 18 publications

(10 citation statements)

References 12 publications

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“…Owing to the high variability of the LAA anatomy, LAA closure with the currently available devices is sometimes very challenging. Previously, the “Kissing Watchman” technique with two Watchman devices and double‐device LAA closure using a combination of Watchman–Amplatzer Plug devices (Abbott Vascular) have been reported to close a large multilobar LAA 2,3 . However, we successfully closed a gigantic LAA using a single LAmbre Closure System.…”

Section: Discussionmentioning

confidence: 94%

“…Previously, the "Kissing Watchman" technique with two Watchman devices and double-device LAA closure using a combination of Watchman-Amplatzer Plug devices (Abbott Vascular) have been reported to close a large multilobar LAA. 2,3 However, we successfully closed a gigantic LAA using a single LAmbre Closure System. Given the simplicity of the procedure, this device may be an optimal solution to close a large LAA percutaneously.…”

Section: Discussionmentioning

confidence: 99%

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Closing gigantic left atrial appendage using a LAmbre Closure System: First implant experience in North America

Inohara

Tsang

Lee

et al. 2020

Cardiovasc electrophysiol

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Introduction: Despite maturing experience and growing procedural familiarity, there remain challenges in percutaneous left atrial appendage (LAA) closure due to anatomical complexities. Methods: We report a complex and extremely large LAA that was successfully closed percutaneously using a LAmbre Closure System (Lifetech Scientific Corp.).Cardiac computed tomography angiography demonstrated a gigantic multilobed LAA measuring 48 × 45.3 mm at the level of the ostium that cannot be occluded by

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Closing gigantic left atrial appendage using a LAmbre Closure System: First implant experience in North America

Inohara

Tsang

Lee

et al. 2020

Cardiovasc electrophysiol

View full text Add to dashboard Cite

show abstract

“…For more complex anatomies that are not compatible with any of the available devices, there are descriptions that prove the feasibility of the off-label implant of a double occluder device, using two dedicated devices or one dedicated device associated with another non-dedicated device. [41][42][43] Such interventions, however, should be considered as an exception, knowing that there is neither enough experience nor follow-up to determine their validity.…”

Section: Journal Of Transcatheter Interventionsmentioning

confidence: 99%

Percutaneous occlusion of the left atrial appendage: the state-of-the-art

Guérios¹,

Chamié²

2019

J Transcat Intervent

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Stroke is the complication of atrial fibrillation with the greatest social and economic impact. The prevalence of this arrhythmia is epidemically growing. Although oral anticoagulants are highly effective, their contraindications, hemorrhagic complications and non-compliance of patients result in underutilization of this therapy. This review addresses aspects related to endocardial occlusion of the left atrial appendage as an alternative strategy to antithrombotic therapy, ranging from the introduction of the technique in clinical practice, the new devices being developed, technical peculiarities, and economic aspects, to uncertainties related to the intervention.

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“…There is a myriad of variations of LAA anatomy in terms of number of lobes and size of orifices [5]. One restriction inherent in single-device LAA occlusion technique concerns the maximum LAA body size suitable for intervention.…”

mentioning

confidence: 99%

Kissing-Watchman technique applied in single-lobulated left atrial appendage anatomy with giant ostia

2020

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The only commercially available device in the documented institution is the Watchman (Boston Scientific, Marlborough, MA, USA) occluder which is the predominant occluder in China. The single device approach may not always fit the great anatomic variability of the left atrial appendage (LAA). Adequate closure may require more than a single device. The commercially available Watchman device only fits LAAs with a maximum diameter of 30 mm [1-3]. In patients with bilobulated LAA, the one-stop implantation of double Watchman is feasible as reported by a previous study [4]. However, it is unknown whether this approach is feasible in the setting of a single-lobulated LAA with a giant ostium (> 30 mm). Reported herein, is a consecutive case series of patients in whom kissing-Watchman was performed to achieve adequate closure of the single-lobulated LAA with large-ostium. Three out of 100 consecutive patients underwent kissing-Watchman occlusion under the guidance of transesophageal echocardiography (TEE). This experimental procedure was preceded with the patient's acceptance. Before intervention, TEE was performed to exclude thrombi in the LAA. The procedures were performed via femoral access under general anesthesia, and were controlled by the angiography and TEE. At the beginning of the intervention, 5000 units of heparin were given. After transseptal passage, TEE measurement of the LAA diameter at the intended implantation site was performed at four different angles. According to the three cases, the maximal LAA ostia diameters were 35, 36, and 33 mm, respectively.

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Percutaneous left atrial appendage closure with complex anatomy by using the staged ‘kissing-Watchman’ technology with double devices

Cited by 18 publications

References 12 publications

Closing gigantic left atrial appendage using a LAmbre Closure System: First implant experience in North America

Closing gigantic left atrial appendage using a LAmbre Closure System: First implant experience in North America

Percutaneous occlusion of the left atrial appendage: the state-of-the-art

Kissing-Watchman technique applied in single-lobulated left atrial appendage anatomy with giant ostia

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