1
|
Dimitriadis K, Pyrpyris N, Aznaouridis K, Adamopoulou E, Soulaidopoulos S, Beneki E, Iliakis P, Fragkoulis C, Aggeli K, Tsioufis K. Transcatheter Structural Heart Disease Interventions and Concomitant Left Atrial Appendage Occlusion: A State of the Art Review. Can J Cardiol 2024:S0828-282X(24)00935-8. [PMID: 39236977 DOI: 10.1016/j.cjca.2024.08.282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 08/28/2024] [Accepted: 08/29/2024] [Indexed: 09/07/2024] Open
Abstract
Atrial fibrillation (AF) is the most common arrhythmia in patients with valvular heart disease, and it can be associated with adverse patient outcomes. However, the need for anticoagulation to counterbalance AF-associated stroke risk may further lead to suboptimal outcomes via increasing bleeding events, especially in high-risk individuals. Because the vast majority of thrombi occur in the left atrial appendage, left atrial appendage occlusion (LAAO) is an established procedure for preventing ischemic stroke in patients with AF, while limiting anticoagulation-related bleeding events. Thus, the concept of combining an index procedure for structural heart disease (SHD) with LAAO seems promising for preventing future stroke events. A combined procedure has been described in aortic stenosis (transcatheter aortic valve implantation + LAAO), mitral regurgitation (transcatheter edge-to-edge repair + LAAO), and atrial septal defects (patent foramen ovale/atrial septal defect + LAAO). Evidence shows that a combined procedure can be safely performed in a "1-stop shop" fashion, without increased rates of procedural adverse events, with the potential to limit bleeding risk and provide prophylaxis against stroke events. This review analyses indications and clinical evidence regarding the safety and efficacy of combined SHD+LAAO procedures, while also providing insights into gaps in knowledge and future directions for the evolution of this field.
Collapse
Affiliation(s)
- Kyriakos Dimitriadis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece.
| | - Nikolaos Pyrpyris
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Konstantinos Aznaouridis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Elena Adamopoulou
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Stergios Soulaidopoulos
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Eirini Beneki
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Panagiotis Iliakis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Christos Fragkoulis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Konstantina Aggeli
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Konstantinos Tsioufis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| |
Collapse
|
2
|
Luo L, Xie Z, Wu Q, Liu Q, Hou H, Wang Y, Shu X. Transesophageal echocardiography guidance for percutaneous closure of PFO and a new method to improve the diagnosis and safety during the procedures. Front Cardiovasc Med 2024; 11:1428380. [PMID: 39145278 PMCID: PMC11321958 DOI: 10.3389/fcvm.2024.1428380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 07/24/2024] [Indexed: 08/16/2024] Open
Abstract
Purpose Percutaneous patent foramen ovale (PFO) closure is becoming more and more common for the treatment or prevention of PFO-associated right-to-left shunt (RLS). This study aims to investigate the value of transesophageal echocardiography (TEE) in percutaneous PFO closure, and to explore a new method that can improve intraoperative diagnosis and surgical safety. Materials and methods Based on our inclusion and exclusion criteria, we enrolled 73 patients between 16 and 70 years old (average age 43.25 ± 14.87 years) who underwent percutaneous PFO closure at the Department of Cardiac Surgery, Zhongshan Hospital (Xiamen), Fudan University, from January 2022 to December 2023. Out of the 73 enrolled patients, there were 28 males (38.36%) and 45 females (61.64%), 29 migraine patients (39.73%), 14 patients (19.19%) with headache and dizziness, 14 patients (19.18%) with a history of cerebral infarction (CI), and 25 patients (34.25%) with CI, lacunar infarction or ischemic focus on magnetic resonance imaging (MRI). All patients received routine transthoracic echocardiography (TTE) and agitated saline contrast echocardiography (ASCE) before operations. Percutaneous closure of PFO was completed under the guidance of TEE. In 12 patients, the method of "injection of heparinized sterile saline through the delivery sheath" was used to observe their RLS, and the anatomical characteristics of the PFO according to the shunt path were monitored and evaluated. This method was also applied to some patients to guide the conveyor to pass through the foramen ovale (FO) channel safely and effectively, thereby improving the success rate of PFO closure. Results The application of TEE during the procedure of percutaneous PFO closure, including preoperative evaluation, intraoperative guidance, and postoperative reevaluation, can offer further details about the anatomical and shunt characteristics of PFO, improve the diagnosis rate, and confirm the safety of the surgical path. It ensures the safety and reliability of the whole operation, greatly improving the success rate and reducing postoperative complications. Conclusions TEE guidance of percutaneous PFO closure has the advantages of minimal trauma, no radiation and real-time visualization, while injecting heparinized sterile saline through the delivery sheath is safer and more effective in improving the success rate and reducing postoperative complications.
Collapse
Affiliation(s)
- Limin Luo
- Department of Echocardiography, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, Fujian, China
| | - Zehan Xie
- Department of Echocardiography, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, Fujian, China
| | - Qiaoyan Wu
- Department of Echocardiography, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, Fujian, China
| | - Qiang Liu
- Department of Echocardiography, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, Fujian, China
| | - Huiping Hou
- Department of Echocardiography, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, Fujian, China
| | - Yongshi Wang
- Department of Echocardiography, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, Fujian, China
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xianhong Shu
- Department of Echocardiography, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, Fujian, China
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China
| |
Collapse
|
3
|
Korsholm K, Jensen JM, Nielsen-Kudsk JE. Left atrial appendage occlusion guided by intracardiac echocardiography in a patient with a 34 mm atrial septal defect occluder: a case report. Eur Heart J Case Rep 2023; 7:ytad571. [PMID: 38046651 PMCID: PMC10691873 DOI: 10.1093/ehjcr/ytad571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/29/2023] [Accepted: 11/14/2023] [Indexed: 12/05/2023]
Abstract
Background Intracardiac echocardiography (ICE)-guided left atrial appendage occlusion (LAAO) is increasingly common. Patients with previous atrial septal defect closure constitute a significant challenge for transseptal access. Case summary A 49-year-old man with persistent atrial fibrillation, hypertension, and reduced left ventricular function was considered for LAAO after a life-threatening intrathoracic bleeding while on oral anticoagulation. Percutaneous atrial septal defect closure was performed 15 years before with a 34 mm Amplatzer Septal Occluder. Preprocedural cardiac computed tomography demonstrated the atrial septal occluder device with a small native interatrial septum at the inferior margin. The left atrial appendage landing zone measured 17 × 22 mm. The LAAO was performed under local analgesia. A steerable sheath was used to guide the transseptal puncture, and the ICE probe was traced along a guidewire across the atrial septum. A 12-F Amulet delivery sheath was advanced through the same transseptal hole. Under ICE and fluoroscopy guidance, a 25 mm Amplatzer Amulet was deployed. Follow-up imaging showed a well-positioned device with a small peridevice leak at the disc. Discussion This case report illustrates the feasibility of LAAO performed with ICE guidance from the left atrium in a patient with a large Amplatzer Septal Occluder with a small native interatrial septum. It demonstrates that prior atrial septal defect closure should not be considered as a contraindication for LAAO but warrants careful preprocedural planning.
Collapse
Affiliation(s)
- Kasper Korsholm
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark
| | - Jesper Møller Jensen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark
| | - Jens Erik Nielsen-Kudsk
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark
| |
Collapse
|
4
|
Song Y, Xing H, Koch PD, Li X, Zhang Y. The feasibility and safety of combining atrial septal defect/patent foramen ovale and left atrial appendage closure: A systematic review and meta-analysis. Front Cardiovasc Med 2023; 9:1080257. [PMID: 36684606 PMCID: PMC9854394 DOI: 10.3389/fcvm.2022.1080257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 12/15/2022] [Indexed: 01/08/2023] Open
Abstract
Introduction Atrial Septal Defect/Patent Foramen Ovale (ASD/PFO) occlusion is performed to prevent paradoxical embolism and reduce the risk of recurrent ischemic stroke. Left atrial appendage (LAA) closure is used as an alternative to medical therapy of non-valvular atrial fibrillation for prevention of stroke. Multiple studies have examined performing LAA and ASD/PFO occlusion. However, the feasibility and safety of combined occlusion of the left atrial appendage and ASD/PFO are not clear, furthermore, these studies are limited by their small sample sizes and retrospective analysis. In this study, we aimed to systematically review and meta-analyze the feasibility and safety of combining left atrial appendage and ASD/PFO closure. Methods PubMed, Web of Science, CNKI, Cochrane Library, Embase, and WanFang database were searched up to April 2022 to identify peer-reviewed human studies on assessing the feasibility, safety, and efficacy of combining left atrial appendage and ASD/PFO closure. The primary outcome was calculated: procedural feasibility outcome and procedural safety outcome. Results A total of 10 articles, including 340 patients from multiple countries, were included in the analysis. The principal findings of our study are: compared with single LAA closure, (i) combining PFO/ASD occlusion and LAA closure had similar procedural success proportion (98.43%, 95% CI: 96.67-100.00%), (ii) similar safety event incidences developed (1.67%, 95% CI: 0.24-3.92%), subgroup analyzed safety event incidences in death was 0.00 (95% CI: 0.00-0.33%), cardiac tamponade was 0.87% (95% CI: 0.00-2.77%), device embolization was 0.00 (95% CI: 0.00-0.60%), major bleeding was 0.00 (95% CI: 0.00-0.33%), stroke was 0.00 (95% CI: 0.00-0.02%). Conclusion Although this systematic review and meta-analysis demonstrate the technical feasibility and safety of combining closure of PFO/ASD and LAA, further studies of sufficient sample size, long-term follow-up, and rigor endpoint criteria are yet needed to fully evaluate this combination procedure for its role in clinical outcomes.
Collapse
Affiliation(s)
- Yi Song
- Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China,*Correspondence: Yi Song,
| | - Hang Xing
- Department of Surgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Peter David Koch
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA, United States
| | - Xiaofei Li
- Division of Cardiology, Department of Medicine, Cardiovascular Research Center, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Yan Zhang
- Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| |
Collapse
|
5
|
Kousa O, Mahfood-Haddad T, Patil SM, Agarwal H, Abuissa H. Left Atrial Appendage Closure in a Patient With a Patent Foramen Ovale Septal Occluder Device. JACC Case Rep 2021; 3:508-511. [PMID: 34317569 PMCID: PMC8311012 DOI: 10.1016/j.jaccas.2021.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 12/22/2020] [Accepted: 01/08/2021] [Indexed: 11/24/2022]
Abstract
Left atrial appendage closure (LAAC) has evolved as a safe alternative to oral anticoagulation therapy for stroke prophylaxis. However, the presence of a patent foramen ovale (PFO) occluder device is considered a relative contraindication. Here we report a successful case of LAAC in the presence of a PFO occluder device. (Level of Difficulty: Beginner.)
Collapse
Affiliation(s)
- Omar Kousa
- Department of Medicine, Creighton University Medical Center, Omaha, Nebraska, USA
| | | | - Shantanu M Patil
- Department of Medicine, Creighton University Medical Center, Omaha, Nebraska, USA
| | - Himanshu Agarwal
- Department of Medicine, Creighton University Medical Center, Omaha, Nebraska, USA
| | - Hussam Abuissa
- Department of Medicine, Creighton University Medical Center, Omaha, Nebraska, USA
| |
Collapse
|
6
|
de Miguel IM, Ávila P. Atrial Fibrillation in Congenital Heart Disease. Eur Cardiol 2021; 16:e06. [PMID: 33737960 PMCID: PMC7967824 DOI: 10.15420/ecr.2020.41] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 12/08/2020] [Indexed: 01/25/2023] Open
Abstract
The increasing prevalence of AF in a growing population of adults with congenital heart disease (CHD) poses new challenges to clinicians involved in the management of these patients. Distinctive underlying anatomies, unique physiological aspects, a high diversity of corrective surgeries and associated comorbidities can complicate clinical decision-making. In this review, the authors provide an overview of the current knowledge on epidemiology and pathophysiology, with a special focus on the differences to the non-CHD population and the clinical impact of AF in adults with CHD. Acute and long-term management strategies are summarised, including the use of antiarrhythmic drugs, catheter or surgical ablation and prophylaxis of thromboembolism. Finally, gaps of knowledge and potential areas of future research are highlighted.
Collapse
Affiliation(s)
- Irene Martín de Miguel
- Cardiology Department, Hospital General Universitario Gregorio Marañón Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón Madrid, Spain.,Faculty of Medicine, Universidad Complutense and CIBERCV Madrid, Spain
| | - Pablo Ávila
- Cardiology Department, Hospital General Universitario Gregorio Marañón Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón Madrid, Spain.,Faculty of Medicine, Universidad Complutense and CIBERCV Madrid, Spain
| |
Collapse
|
7
|
Matta M, Maltese L, Ugo F, Di Ruocco MV, Rametta F. Feasibility and safety of left atrial appendage closure in a patient with previous foramen ovale occlusion: a case report. Eur Heart J Case Rep 2021; 5:ytab113. [PMID: 33824939 PMCID: PMC8010339 DOI: 10.1093/ehjcr/ytab113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/13/2020] [Accepted: 03/10/2021] [Indexed: 11/13/2022]
Abstract
Background Left atrial appendage (LAA) closure is an alternative to chronic oral anticoagulation for stroke prevention in patients with atrial fibrillation (AF) at high bleeding risk. Patients with a previous percutaneous closure of a patent foramen ovale (PFO) present an increased risk for developing AF during their life, and the presence of an atrial septal device renders future percutaneous left atrial access more challenging. Very few cases of LAA occlusion in patients with a preexisting PFO closure device have been previously reported. Case summary A 74-years old woman was admitted to our hospital for symptomatic severe anaemia during direct oral anticoagulant treatment. Her past medical history reported an ischaemic stroke at the age of 55, at that time a PFO was diagnosed and a STARFlex™ PFO occluder (NMT Medical, Boston, MA, USA) was implanted. During the current hospitalization, the patient underwent a colonoscopy that showed colonic angiodysplasias unsuitable for endoscopic treatment and LAA closure was indicated for stroke prevention. After a multimodality pre-procedural planning that included a transoesophageal echocardiogram, a cardiac computed tomography scan and a three-dimensional cardiac model printing, the procedure was planned and the LAA successfully occluded. Discussion LAA closure can be performed safely and effectively in patients carrying a previously implanted PFO occlusion device. In complex settings, a pre-procedural multimodality imaging is critical for improving the procedural safety and success rate. We describe the first case of percutaneous LAA closure in a patient with a prior PFO occlusion with the implantation of a STARflex™ septal occlusion device.
Collapse
Affiliation(s)
- Mario Matta
- Cardiology Division, Sant’Andrea Hospital, Corso Mario Abbiate 21, 13100, Vercelli, Italy
| | - Ludovica Maltese
- Cardiology Division, Sant’Andrea Hospital, Corso Mario Abbiate 21, 13100, Vercelli, Italy
| | - Fabrizio Ugo
- Cardiology Division, Sant’Andrea Hospital, Corso Mario Abbiate 21, 13100, Vercelli, Italy
| | | | - Francesco Rametta
- Cardiology Division, Sant’Andrea Hospital, Corso Mario Abbiate 21, 13100, Vercelli, Italy
| |
Collapse
|
8
|
Raghuram P, Pavithran S, Sivakumar K. Unconventional combination of left atrial appendage device occlusion in patients with atrial fibrillation who needed concomitant catheter interventions for underlying structural heart disease. Indian Heart J 2020; 72:369-375. [PMID: 33189196 PMCID: PMC7670275 DOI: 10.1016/j.ihj.2020.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 07/04/2020] [Accepted: 07/17/2020] [Indexed: 11/25/2022] Open
Abstract
Objectives Left atrial appendage occlusion (LAAO) in non-valvar atrial fibrillation (AF) reduces cardioembolic strokes. Despite increased risk, trials exclude valvar AF in structural heart diseases where clots extend beyond appendage. Methods Patients with AF and relative risks for oral anticoagulation (OAC) needing structural interventions underwent concomitant LAAO. After six months of OAC, aspirin was continued. Transesophageal echocardiogram was done three monthly till one year and yearly thereafter. The patient demographics, procedural details, post-procedural follow-up were analyzed. Results Nine patients aged 51.5 ± 6.3 years with AF underwent LAAO concomitantly with balloon mitral valvotomy in four patients, atrial septal defect device closure in four and periprosthetic mitral leak closure in one patient. Six patients had heart failure, four had prior embolic events, and two had documented LAA thrombus. The mean CHADS2VASc score was 2.44 ± 0.8 and mean HASBLED score was 3.0 ± 0.8. Devices included Amplatzer Cardiac Plug™ in six patients, LAmbre™ Lifetech device in two and Watchman™ device in one. All procedures were successful without acute complications. A patient developed pericardial effusion at six months requiring pericardiocentesis. Early device-associated thrombus in one patient resolved after OAC for six months. No embolic events occurred on follow-up. Conclusion On a detailed literature search, this largest LAAO experience in structural heart diseases indicates its utility. OAC for six months followed by aspirin seems to prevent thrombus formation in these patients. The only incidence of early thrombus formation indicates immunity from clot formation after device endothelialisation. Larger multicenter trials combining LAAO with structural interventions in valvular AF are warranted in developing nations.
Collapse
Affiliation(s)
- Palaparti Raghuram
- Department of Pediatric Cardiology, Madras Medical Mission, Chennai, India
| | - Sreeja Pavithran
- Department of Pediatric Cardiology, Madras Medical Mission, Chennai, India
| | | |
Collapse
|
9
|
Yap J, Chen S, Stripe BR, Smith TWR, Rogers JH, Singh GD. Transseptal access for left heart structural interventions in the setting of prior atrial septal defect closure. Catheter Cardiovasc Interv 2020; 95:414-419. [PMID: 31638326 DOI: 10.1002/ccd.28548] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 10/05/2019] [Indexed: 11/09/2022]
Abstract
A transseptal puncture is critical for "left-sided" structural heart interventions. Procedures such as transcatheter edge-to-edge repair (MitraClip) and left atrial appendage (LAA) closure (Watchman) require precise puncture of the interatrial septum (IAS), and the presence of a prior atrial septal defect (ASD) closure device poses a challenge. We aim to present a successfully completed case of MitraClip and Watchman in the presence of ASD closure device in two different patients. A review of the literature will be reported, and pertinent clinical and technical considerations will be discussed in depth to achieve procedural success. In summary, transseptal puncture for left heart structural interventions is feasible in the presence of a prior ASD/patent foramen ovale closure device. A detailed understanding of the anatomical considerations as well as the use of multimodality imaging to evaluate the IAS will aid in improving procedural success rates.
Collapse
Affiliation(s)
- Jonathan Yap
- Division of Cardiovascular Medicine, University of California Davis, Sacramento, California.,Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Sarah Chen
- Division of Cardiovascular Medicine, University of California Davis, Sacramento, California
| | - Benjamin R Stripe
- Division of Cardiovascular Medicine, University of California Davis, Sacramento, California
| | - Thomas W R Smith
- Division of Cardiovascular Medicine, University of California Davis, Sacramento, California
| | - Jason H Rogers
- Division of Cardiovascular Medicine, University of California Davis, Sacramento, California
| | - Gagan D Singh
- Division of Cardiovascular Medicine, University of California Davis, Sacramento, California
| |
Collapse
|
10
|
Yu J, Liu X, Zhou J, Xue X, Muenzel M, Schulze PC, Moebius-Winkler S, Keil T, Meng Z, Tang S. Long-term safety and efficacy of combined percutaneous LAA and PFO/ASD closure: a single-center experience (LAAC combined PFO/ASD closure). Expert Rev Med Devices 2019; 16:429-435. [PMID: 30999776 DOI: 10.1080/17434440.2019.1604216] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To report long-term safety and efficacy of combined percutaneous LAA and PFO/ASD closure. METHODS A retrospective study of 370 consecutive patients undergoing LAAC procedures using the Watchman (WM) device. Data were compared between 330 cases only with LAAC procedure (Group I) and 25/5 (PFO/ASD) cases with sequential procedures of LAAC and PFO/ASD closure (Group II). RESULTS Compared to Group I, Group II had more males (86.7% vs. 65.8%, p < 0.05) and a higher rate of stroke (33.3% vs. 10.6%, p < 0.01), but there were no statistical differences in the remaining patient characteristics. During the follow-up period, there were no significant differences between the two groups in embolism events (6.1% vs. 0%, p = 0.39), device related thrombus (5.8% vs 3.3%, p = 1.0), major bleeding (9.4% vs. 6.7%, p = 1.0) and cardiac death (3.6% vs. 0%, p = 0.61). The observed rate of all thromboembolic events by Kaplan-Meier analysis was decreased by 39.9% and 100% and the observed annual rate of bleeding was reduced by 32.9% and 57.6% in Group I and Group II, respectively. CONCLUSIONS LAAC combined with PFO/ASD closure might be an ideal choice to prevent stroke and other thrombotic complications in patients with both NVAF and PFO/ASD.
Collapse
Affiliation(s)
- Jiangtao Yu
- a Clinic for General Internal Medicine and Cardiology , Marienhof Katholisches Klinikum Koblenz·Montabaur , Koblenz , Germany.,b Department of Cardiology , Helmut-G.-Walther-Klinikum , Lichtenfels , Germany
| | - Xiaoxia Liu
- c Department of Cardiology , the 4th Hospital of Harbin Medical University , Harbin , PR China
| | - Junling Zhou
- b Department of Cardiology , Helmut-G.-Walther-Klinikum , Lichtenfels , Germany.,d Department of Cardiology , the Provincial Hospital Anhui , Hefei , PR China
| | - Xin Xue
- b Department of Cardiology , Helmut-G.-Walther-Klinikum , Lichtenfels , Germany.,e Department of Cardiology , The Second Hospital, Jilin University , Changchun , PR China
| | - Manuela Muenzel
- b Department of Cardiology , Helmut-G.-Walther-Klinikum , Lichtenfels , Germany
| | - P Christian Schulze
- f Department of Internal Medicine I, Division of Cardiology , University Hospital Jena, Friedrich-Schiller-University , Jena , Germany
| | - Sven Moebius-Winkler
- f Department of Internal Medicine I, Division of Cardiology , University Hospital Jena, Friedrich-Schiller-University , Jena , Germany
| | - Thorsten Keil
- g Department of Anesthesiology , Helmut-G.-Walther-Klinikum , Lichtenfels , Germany
| | - Zhaohui Meng
- b Department of Cardiology , Helmut-G.-Walther-Klinikum , Lichtenfels , Germany.,h Department of Cardiology , The 1st Hospital of Kunming Medical University , Kun-ming , PR China
| | - Shaoyong Tang
- i Department of Cardiology , Wuhan N0.4 Hospital , Wuhan , PR China
| |
Collapse
|
11
|
Nadel J, Subbiah R, Jacobs N, Muller DWM, Gunalingam B. Successful left atrial appendage closure in a patient with prior patent foramen ovale occlusion. HeartRhythm Case Rep 2019; 5:183-186. [PMID: 30997330 PMCID: PMC6453555 DOI: 10.1016/j.hrcr.2018.11.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- James Nadel
- Department of Cardiology, St. Vincent's Hospital, Darlinghurst, Sydney, NSW, Australia
| | - Rajesh Subbiah
- Department of Cardiology, St. Vincent's Hospital, Darlinghurst, Sydney, NSW, Australia.,Victor Chang Cardiac Research Institute, Darlinghurst, Sydney, NSW, Australia
| | - Neil Jacobs
- Department of Cardiology, St. Vincent's Hospital, Darlinghurst, Sydney, NSW, Australia
| | - David W M Muller
- Department of Cardiology, St. Vincent's Hospital, Darlinghurst, Sydney, NSW, Australia.,Victor Chang Cardiac Research Institute, Darlinghurst, Sydney, NSW, Australia
| | - Brendan Gunalingam
- Department of Cardiology, St. Vincent's Hospital, Darlinghurst, Sydney, NSW, Australia
| |
Collapse
|
12
|
Piccini JP, Sievert H, Patel MR. Left atrial appendage occlusion: rationale, evidence, devices, and patient selection. Eur Heart J 2018; 38:869-876. [PMID: 27628431 DOI: 10.1093/eurheartj/ehw330] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 07/11/2016] [Indexed: 02/06/2023] Open
Abstract
Atrial fibrillation (AF) is a worldwide epidemic associated with significant morbidity and mortality, often due to disabling or fatal thromboembolic stroke. Oral anticoagulation is highly effective at preventing ischaemic stroke and improving all-cause survival in patients with non-valvular AF. Despite the efficacy of oral anticoagulation, many patients are not treated due to either absolute or perceived contraindications to therapy, including bleeding. Left atrial appendage (LAA) closure has emerged as a mechanical alternative to pharmacologic stroke prevention. Initial and mid-term clinical trial data suggest that LAA closure is safe, with less intracranial bleeding, and a net clinical benefit that appears to be non-inferior to oral anticoagulation. However, concern remains over the possible increased risk of ischaemic stroke in long-term follow-up. Careful patient selection for LAA closure is paramount. Patients with prior intracranial bleeding or recurrent serious bleeding who are not eligible for long-term oral anticoagulation are typical candidates for LAA closure; however, other populations may benefit as well, such as patients with end-stage renal disease. Clinical investigation and randomized trials are needed to clarify the best methods of LAA occlusion, optimal pharmacologic strategies in the short-term after LAA closure, and to identify patient populations who will derive the most benefit from LAA occlusion. In this article, we review the rationale for LAA closure, the currently available devices and their evidence base, patient selection, challenges in management, and future directions for LAA closure science.
Collapse
Affiliation(s)
- Jonathan P Piccini
- Duke Center for Atrial Fibrillation, Durham, NC, USA.,Duke University Medical Center, Durham, NC, USA.,Duke Clinical Research Institute, Durham, NC, USA
| | - Horst Sievert
- CardioVascular Center Frankfurt, Sankt Katharinen Hospital, Frankfurt, Germany
| | - Manesh R Patel
- Duke Center for Atrial Fibrillation, Durham, NC, USA.,Duke University Medical Center, Durham, NC, USA.,Duke Clinical Research Institute, Durham, NC, USA
| |
Collapse
|
13
|
Song S, Lee OH, Kim JS, Cho IJ, Shim CY, Hong GR, Pak HN, Jang Y. Simultaneous Closure of a Left Atrial Appendage through an Atrial Septal Defect and the Atrial Septal Defect. Yonsei Med J 2017; 58:1237-1240. [PMID: 29047250 PMCID: PMC5653491 DOI: 10.3349/ymj.2017.58.6.1237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 12/11/2016] [Accepted: 01/10/2017] [Indexed: 11/30/2022] Open
Abstract
Left atrial appendage (LAA) occlusion can be employed as an alternative treatment to oral anticoagulation in patients with atrial fibrillation to prevent embolic events. Atrial septal defect (ASD) may be related with right heart dysfunction and allow paradoxical embolism to occur. However, occlusion of both LAA through atrial access with ostium secundum ASD and ASD in the same setting is unusual. Therefore, we report a case in which a LAA and an ASD was sequentially occluded.
Collapse
Affiliation(s)
- Shinjeong Song
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Oh Hyun Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Jung Sun Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
- Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea.
| | - In Jeong Cho
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Chi Young Shim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Geu Ru Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Hui Nam Pak
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Yangsoo Jang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
- Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
14
|
Heersink D, Murdoch D, Humphries J, Walters DL. Left Atrial Appendage Closure Device Implantation After Percutaneous Atrial Septal Defect Closure. JACC Cardiovasc Interv 2016; 9:e95-6. [PMID: 27131442 DOI: 10.1016/j.jcin.2016.02.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 02/11/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Damion Heersink
- Department of Cardiology, Prince Charles Hospital, Chermside, Queensland, Australia; University of Queensland, Brisbane, Queensland, Australia
| | - Dale Murdoch
- Department of Cardiology, Prince Charles Hospital, Chermside, Queensland, Australia; University of Queensland, Brisbane, Queensland, Australia.
| | - Julie Humphries
- Department of Cardiology, Prince Charles Hospital, Chermside, Queensland, Australia; University of Queensland, Brisbane, Queensland, Australia
| | - Darren L Walters
- Department of Cardiology, Prince Charles Hospital, Chermside, Queensland, Australia; University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
15
|
Akinapelli A, Bansal O, Chen JP, Pflugfelder A, Gordon N, Stein K, Huibregtse B, Hou D. Left Atrial Appendage Closure -The WATCHMAN Device. Curr Cardiol Rev 2015; 11:334-340. [PMID: 26242188 PMCID: PMC4774639 DOI: 10.2174/1573403x11666150805115822] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Atrial fibrillation (AF) is one of the most common arrhythmias seen in clinical cardiology practice. Patients
with non-valvular AF have an approximately 5-fold increase in the risk of stroke, with an exponential increase with advancing
age. Cardioembolic strokes carry a high mortality risk. Although the potential of warfarin to reduce systemic embolization
in AF patients is well established, its use is difficult due to narrow therapeutic windows and additional complications
(e.g. increased risk of bleeding), especially for aging patients. Therefore, alternative means of treatment to reduce
stroke risk in these patients are needed. The left atrial appendage is the major source of thrombus formation in patients
with non-valvular AF. The WATCHMAN device (Boston Scientific, MA) is a percutaneous left atrial appendage closure
device which has been tested prospectively in multiple randomized trials. It offers a new stroke risk reduction option for
high-risk patients with non-valvular atrial fibrillation who are seeking an alternative to long-term warfarin therapy. Based
on the robust WATCHMAN clinical program which consists of numerous studies, with more than 2,400 patients and
nearly 6,000 patient-years of follow-up, the WATCHMAN LAAC Device is approved by FDA. In this article we reviewed
the preclinical studies and clinical trials, as well as the next generation of the device.
Collapse
|