Surgical left atrial appendage occlusion: evaluation of a novel device with magnetic resonance imaging☆

Salzberg, Sacha P.; Gillinov, A. Marc; Anyanwu, Anelechi C.; Castillo, Javier G.; Filsoufi, Farzan; Adams, David H.

doi:10.1016/j.ejcts.2008.05.058

Cited by 50 publications

(35 citation statements)

References 14 publications

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“…In our group of patients, the left atrial appendage was surgically excised in all patients, which may contribute to the improved survival due to the lower risk of thrombo-embolic events [16]. Interestingly, a significant number of our patients remained on coumadin, despite being in sinus rhythm due to other indications.…”

Section: Discussionmentioning

confidence: 98%

The impact of surgical ablation in patients with low ejection fraction, heart failure, and atrial fibrillation

Ad¹,

Henry²,

Hunt

2011

European Journal of Cardio-Thoracic Surgery

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This is a unique study assessing a high-risk group of patients. Surgical ablation in patients with low EF can be performed in a safe and effective way without added operative risk. Given the potential long-term clinical advantages of a successful surgical ablation in patients with low EF and heart failure, we believe that surgical ablation should be considered in such patients when they present to surgery.

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Section: Discussionmentioning

confidence: 98%

The impact of surgical ablation in patients with low ejection fraction, heart failure, and atrial fibrillation

Ad¹,

Henry²,

Hunt

2011

European Journal of Cardio-Thoracic Surgery

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“…Although stapling techniques are particularly attractive in minimally invasive approaches to AF surgery, this study suggests they are largely ineffective, possibly because the stapler cannot generally be applied down to the true base of the appendage. There is a need for further research into alternative strategies to exclude the left atrial appendage (39); decision making regarding anticoagulation therapy management and the safety of cardioversion in the post-operative setting should not be altered unless an imaging study has confirmed the success of a surgical left atrial appendage closure procedure.…”

Section: Atrial Fibrillationmentioning

confidence: 98%

The Year in Cardiovascular Surgery

Adams

Anyanwu

Chikwe

et al. 2009

Journal of the American College of Cardiology

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It is a great challenge to take over the responsibility of providing readers of the JACC with this annual review that highlights key contributions in the cardiovascular surgery literature. This task has been handled with remarkable and enviable efficiency by Robert H. Jones, MD, over the past 5 years. During the series, Dr. Jones altered the format from time to time, generally focusing on reports linking outcomes of patients to decisions about whether an operation should be done. Recognizing the increasing awareness of patients regarding the "how" of surgical procedures, he also sought to highlight relevant data that would help practicing cardiologists counsel patients regarding surgical strategy.This year we will continue to highlight articles describing outcomes as well as strategy in cardiovascular surgery that practicing cardiovascular specialists will find informative and relevant to patient care. We have organized original articles around general topics, and provide insight into the potential relevance or methodological flaws that readers should consider when evaluating their significance. Surgery for Valvular Heart DiseaseRestrictive annuloplasty and ischemic mitral regurgitation. FUNCTIONAL MITRAL STENOSIS. Dobutamine stress echocardiography (DSE) and 6-min walk tests (6MWT) were performed in 24 patients Ϸ1 year after ischemic mitral valve repair by a strategy of downsized "restrictive" ring annuloplasty combined with coronary artery bypass graft surgery (CABG) (1). None of the patients had significant recurrence of mitral regurgitation. When compared with controls with coronary artery disease matched for age, sex, and left ventricular function, however, very significant differences (p Ͻ 0.001) were noted in resting and stress peak mitral valve gradients (resting: 13 Ϯ 4 mm Hg vs. 4 Ϯ 1 mm Hg; DSE: 19 Ϯ 6 mm Hg vs. 6 Ϯ 3 mm Hg) and pulmonary artery pressures (resting: 42 Ϯ 13 mm Hg vs. 27 Ϯ 8 mm Hg; DSE: 58 Ϯ 12 mm Hg vs. 38 Ϯ 11 mm Hg). The resting peak mitral gradient correlated with systolic pulmonary artery pressures and 6MWT distance in the restrictive annuloplasty group, suggesting that some patients may trade moderate or severe ischemic mitral regurgitation for functional mitral stenosis after restrictive annuloplasty (Fig. 1). LEFT VENTRICULAR REVERSE REMODELING AND IMPROVEDSURVIVAL. Long-term results were reported for 108 patients with ischemic mitral regurgitation who underwent restrictive mitral annuloplasty and CABG (2). Actuarial 1-, 3-, and 5-year survival rates were 87 Ϯ 3.4%, 80 Ϯ 4.1%, and 71 Ϯ 5.1%. Pre-operative left ventricular end-diastolic diameter (LVEDD) Ͼ65 mm was strongly associated with poorer survival (hazard ratio: 3.4: 95% confidence interval [CI]: 1.5 to 7.4; p ϭ 0.002) (Fig. 2). Late echocardiography was performed in all survivors (n ϭ 75), with a mean follow-up interval of 3.8 years (range 2.1 to 6.0 years). Mitral regurgitation grade was Ͻ2ϩ in 85% of patients, and mitral stenosis was not observed (transmitral gradient mean 3.9 Ϯ 1.7 mm Hg). In the Յ65 mm LVEDD group, all...

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“…After this, several studies have been published showing the feasibility of this minimally invasive method, most of them using a stapler or a loop snare 31,36,37. One technique has been developed to clip the LAA 38. This device is constructed from two stainless steel strips covered with a knit braided polyester fabric (AtriCure, Inc., West Chester, OH, USA) and can be implanted at the base of the LAA 37,39,40.…”

Section: Current Therapeutic Strategies To Prevent Stroke In Afmentioning

confidence: 99%

Novel stroke risk reduction in atrial fibrillation: left atrial appendage occlusion with a focus on the Watchman closure device

Alipour

Wintgens

Swaans

et al. 2017

VHRM

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Atrial fibrillation (AF) remains an important clinical problem with severe complications such as stroke, which especially harms those with risk factors as calculated by the CHADS 2 or CHA 2 DS 2 -VASc. Until now, no therapy has proven 100% effective against AF. Since the left atrial appendage (LAA) is the most prominent nonvalvular AF-related thromboembolic source and (novel) oral anticoagulant [(N)OAC] carries the hazard of bleeding, LAA occlusion may be an alternative, especially in patients who are ineligible for (N)OAC therapy. In this review, we discuss several LAA occlusion techniques with a focus on the Watchman device since this device is the most thoroughly studied device of all.

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Surgical left atrial appendage occlusion: evaluation of a novel device with magnetic resonance imaging☆

Abstract: We demonstrated a safe, straightforward, persistent and effective method for LAA occlusion with this new LAA clip. MRI effectively demonstrated LAA occlusion and only minor changes in left ventricular volumes.

Cited by 50 publications

References 14 publications

The impact of surgical ablation in patients with low ejection fraction, heart failure, and atrial fibrillation

The impact of surgical ablation in patients with low ejection fraction, heart failure, and atrial fibrillation

The Year in Cardiovascular Surgery

Novel stroke risk reduction in atrial fibrillation: left atrial appendage occlusion with a focus on the Watchman closure device

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