Use of a novel septal occluder device for left atrial appendage closure in patients with postsurgical and postlariat leaks or anatomies unsuitable for conventional percutaneous occlusion

Domenico G. Della Rocca, Rodney P. Horton, Nicola Tarantino, Christoffel Johannes Van Niekerk, Chintan Trivedi, Qiong Chen, Sanghamitra Mohanty, Alisara Anannab, Ghulam Murtaza, Krishna Akella, Carola Gianni, Mohamed Bassiouny, Ashkan Ahmadian-Tehrani, Amin Al-Ahmad, J. David Burkhardt, Veronica N. Natale, Matthew Price, G. Joseph Gallinghouse, Douglas N. Gibson, Dhanunjaya LakkireddyLuigi Di Biase, Andrea Natale

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: Interventional therapies aiming at excluding the left atrial appendage (LAA) from systemic circulation have been established as a valid alternative to oral anticoagulation in patients at high thromboembolic risk. However, their efficacy on stroke prophylaxis may be compromised owing to incomplete LAA closure. Additionally, the need for an alternative thromboembolic prevention may remain unmet in patients with contraindications to oral anticoagulation whose appendage anatomy is unsuitable for some conventional devices commercially available. We aimed at evaluating the feasibility of LAA closure with the novel Gore Cardioform Septal Occluder in patients with incomplete appendage ligation or anatomic features which do not meet the manufacturer's requirements for Watchman deployment. METHODS: Twenty-one consecutive patients (mean age: 72±6 years; 85.7% males; CHA2DS2-VASc: 4.5±1.4; HAS-BLED: 3.6±1.0) were included. Transesophageal echocardiography was performed within 2 months to assess for residual LAA patency. RESULTS: Fourteen patients had incomplete LAA closure following surgical (n=6) or Lariat ligation (n=8). In 7 patients with an appendage anatomy unsuitable for Watchman deployment, the mean maximal landing zone size and LAA depth were 14.4±1.3 and 18.6±2.8 mm. Successful Cardioform Septal Occluder deployment was achieved in all patients. No periprocedural complications were documented. Procedure and fluoroscopy times were 46±13 and 14±5 minutes. Follow-up transesophageal echocardiography after 58±9 days revealed complete LAA closure in all patients. CONCLUSIONS: Transcatheter LAA closure via a Cardioform Septal Occluder device might be a valid alternative in patients with residual leaks following failed appendage ligation or whose LAA anatomy does not meet the minimal anatomic criteria to accommodate a Watchman device.

Original languageEnglish (US)
Article numbere009227
Pages (from-to)172-180
Number of pages9
JournalCirculation: Cardiovascular Interventions
DOIs
StateAccepted/In press - 2020

Keywords

  • Atrial appendage
  • Atrial fibrillation
  • Mitral valve
  • Patent foramen ovale
  • Transoesophageal echocardiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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