Percutaneous Left Atrial Appendage Occlusion (PLAATO) for Preventing Cardioembolism

Nakai, Toshiko; Lesh, Michael D.; Gerstenfeld, Edward P.; Virmani, Renu; Jones, Russell M.; Lee, Randall J.

doi:10.1161/01.cir.0000015605.30810.51

Cited by 127 publications

(84 citation statements)

References 25 publications

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“…Several reports of preclinical data and human feasibility trials document successful endocardial application of implants and the possibility of stroke prevention. 14,15 In the first prospective, randomized trial of its type, the Embolic Protection in Patients with Atrial Fibrillation study showed that in patients with AF who were candidates for warfarin therapy, device closure of the LAA was associated with a reduction in hemorrhagic stroke risk compared with warfarin. All-cause stroke and all-cause mortality outcomes were noninferior to warfarin.…”

Section: Clinical Perspective On P 229mentioning

confidence: 99%

Catheter-Based Left Atrial Appendage (LAA) Ligation for the Prevention of Embolic Events Arising From the LAA

Lee

Bartuś

Yakubov

2010

Circ: Cardiovascular Interventions

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Background-Surgical ligation of the left atrial appendage (LAA) has been shown to be an effective alternative to warfarin therapy in patients with atrial fibrillation. A novel catheter-based approach for LAA ligation was evaluated for safety and effectiveness in a canine model. Methods and Results-A total of 26 healthy mongrel dogs underwent ligation of the LAA through a catheter-based approach.Intracardiac echocardiography and contrast fluoroscopy were used to position a marker balloon at the origin of the LAA. An over-the-wire approach was used to guide the LARIAT snare device over the LAA to enable ligation of the LAA. Sixteen dogs were euthanized acutely. The LAA was examined to assess the placement and completeness of the ligation. The remaining 10 dogs were used for long-term follow-up. The snare delivery device was able to completely capture, advance, and close the anatomic base of the LAA in all cases. In all animals, complete LAA exclusion through this closed-chest approach was achieved without complications. Chronic follow-up revealed healthy active dogs. Examination of the LAA at 7 days, 1 month, and 3 months demonstrated completely endothelialized orifice of the LAA. Conclusions-Using a closed-chest approach in the canine model, the catheter-based snare delivery device achieved safe and reliable ligation of the entire LAA. The clinical application of this novel approach may provide an alternative to warfarin or to permanent device implants in patients with nonvalvular atrial fibrillation for the prevention of embolic events originating from the LAA. (Circ Cardiovasc Interv. 2010;3:224-229.)

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Section: Clinical Perspective On P 229mentioning

confidence: 99%

Catheter-Based Left Atrial Appendage (LAA) Ligation for the Prevention of Embolic Events Arising From the LAA

Lee

Bartuś

Yakubov

2010

Circ: Cardiovascular Interventions

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“…Studies in dogs demonstrated the ability of the device to seal the LAA. 5 We report our initial experience in humans.…”

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confidence: 99%

Percutaneous Left Atrial Appendage Transcatheter Occlusion to Prevent Stroke in High-Risk Patients With Atrial Fibrillation

et al. 2002

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Background-Thromboembolism due to atrial fibrillation (AF) is a frequent cause of stroke. More than 90% of thrombi in AF form in the left atrial appendage (LAA). Obliteration of the appendage may prevent embolic complications. Methods and Results-We evaluated the feasibility and safety of implanting a novel device for percutaneous left atrial appendage transcatheter occlusion (PLAATO). LAA occlusion using the PLAATO system was attempted in 15 patients with chronic AF at high risk for stroke, who are poor candidates for long-term warfarin therapy. The implant consists of a self-expanding nitinol cage covered with a polymeric membrane (ePTFE). The LAA was successfully occluded in 15/15 patients (100%). Angiography and transesophageal echocardiography (TEE) during the procedure showed that the device was well-seated in all patients and that there was no evidence of perforation, device embolization, or interference with surrounding structures. In 1 patient, the first procedure was complicated by a hemopericardium, which occurred during LAA access. A second attempt 30 days later was successful with no untoward sequela. No other complications occurred. At 1-month follow-up, chest fluoroscopy and TEE revealed continued stable implant position with smooth atrial-facing surface and no evidence of thrombus. Conclusions-Thus, transcatheter closure of the LAA is feasible in humans. This novel implant technology may be appropriate for patients with AF who are not suitable candidates for anticoagulation therapy. Further trials are needed to show the long-term safety and its efficacy in reducing stroke.

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“…26,27 The PLAATO device consists of a self-expandable nitinol cage covered with an occlusive expanded polytetrafluoroethylene membrane ( Figure 1). The membrane occludes the orifice of the LAA but allows tissue incorporation into the device, and small anchors along the struts to assist with device anchoring and encourage healing.…”

Section: The Plaato Systemmentioning

confidence: 99%

“…26,28 Initial animal study and early clinical experience have shown the feasibility of the PLAATO procedure. 26,27 Recently, results of two concurrent feasibility studies that were conducted in Europe and North America were published. 28 The LAA occlusion was successful in 108 of 111 (97.3%) patients with nonrheumatic AF who were at high risk for ischemic stroke and not candidates for long-term OAC.…”

Section: The Plaato Systemmentioning

confidence: 99%

Left Atrial Appendage Exclusion for Stroke Prevention in Patients With Nonrheumatic Atrial Fibrillation

Özer

Crystal

2007

Stroke

111

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Abstract-The efficacy of oral anticoagulation (OAC) for stroke prevention in patients with nonrheumatic atrial fibrillation (AF) has clearly been established. However, a substantial number of patients with AF who are at high risk for thromboembolic events are not candidates for long-term OAC. The left atrial appendix (LAA) is the most common place of thrombosis in patients with AF, and it can easily be excluded from the systemic circulation at the time of cardiac surgery by excision, ligation, suturing, or stapling. Currently, removal of the LAA at the time of mitral valve surgery is recommended to reduce future stroke risk.

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Percutaneous Left Atrial Appendage Occlusion (PLAATO) for Preventing Cardioembolism

Cited by 127 publications

References 25 publications

Catheter-Based Left Atrial Appendage (LAA) Ligation for the Prevention of Embolic Events Arising From the LAA

Catheter-Based Left Atrial Appendage (LAA) Ligation for the Prevention of Embolic Events Arising From the LAA

Percutaneous Left Atrial Appendage Transcatheter Occlusion to Prevent Stroke in High-Risk Patients With Atrial Fibrillation

Left Atrial Appendage Exclusion for Stroke Prevention in Patients With Nonrheumatic Atrial Fibrillation

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