A novel device for left atrial appendage exclusion

Kamohara, Keiji; Fukamachi, Kiyotaka; Ootaki, Yoshio; Akiyama, Mitoshi; Zahr, Firas; Kopcak, Michael W.; Dessoffy, Raymond; Popović, Zoran B.; Daimon, Masao; Cosgrove, Delos M.; Gillinov, A. Marc

doi:10.1016/j.jtcvs.2005.08.019

Cited by 33 publications

(22 citation statements)

References 29 publications

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“…Early surgical approaches to LAA ligation included stapling or suture closures. Purse-string sutures have been associated with a “puckered” suture line, which is thought to precipitate thrombus formation on the endocardial surface 11. Other epicardial approaches using the stapling method have led to LAA tears 1 12.…”

Section: Discussionmentioning

confidence: 99%

Occluding the left atrial appendage: anatomical considerations

Su¹,

McCarthy

2008

Heart

150

106

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Section: Discussionmentioning

confidence: 99%

Occluding the left atrial appendage: anatomical considerations

Su¹,

McCarthy

2008

Heart

150

106

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“…Preclinical studies with a simple left atrial appendage clip confirm complete exclusion of the left atrial appendage from the body of the left atrium and long-term safety of the implant (Figure 3). 50 This and other new technologies for minimally invasive epicardial ablation of the left atrial appendage will soon be available for clinical use. Clinical trials are being designed to test the hypothesis that epicardial, device-based exclusion of the left atrial appendage will reduce the risks of stroke and other thromboembolism in patients with AF.…”

Section: Future Directions: the Left Atrial Appendagementioning

confidence: 99%

Advances in Surgical Treatment of Atrial Fibrillation

Gillinov

2007

Stroke

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Abstract-Atrial fibrillation (AF) is the most common sustained arrhythmia. It is associated with increased risks of death and stroke; most strokes in AF patients are thought to arise from thrombi in the left atrial appendage. Surgical ablation of AF includes excision of the left atrial appendage and is an effective means of treating this arrhythmia, with the classic Maze procedure curing AF in Ͼ90% of patients and virtually eliminating the risk of late stroke. A complex but safe operation, the Maze procedure has been applied by relatively few surgeons. Americans; this number is expected to increase to Ͼ5.6 million by 2050. 1 The prevalence of AF increases with increasing patient age, and recent data from the Framingham Heart Study suggest that the lifetime risks for development of AF are 1 in 4 for men and women aged Ն40 years. 2 This epidemic has a growing impact on the healthcare system and a multibillion dollar cost. The clinical consequences of AF are well documented. AF is associated with reduced life expectancy and increases the risk of stroke 5-fold, accounting for Ϸ15% of all strokes nationally. 3-8 These AF-related strokes are a major challenge and a focus of several clinical trials investigating strategies for primary and secondary prevention. 4 Currently, antithrombotic therapy is the mainstay for stroke prevention in AF patients.Although there is currently some consensus concerning pharmacological strategies for stroke prevention in AF patients, choice of therapy for the heart rhythm is controversial and evolving. 9,10 Available antiarrhythmic therapies inconsistently restore sinus rhythm and are associated with complications. In fact, the risks associated with antiarrhythmic drug therapy may counterbalance the potential benefit of restoration of sinus rhythm. 9,10 These observations, coupled with increased understanding of the pathogenesis of AF, have resulted in the development of interventional strategies to restore sinus rhythm. Both catheter-based and surgical approaches have demonstrated effectiveness in this regard. Developed by Dr James Cox, the classic Maze procedure is the predicate operation for ablation of AF; long-term data suggest that the Maze procedure eliminates AF in Ͼ90% of patients. 11-14 Despite these unmatched results, the complexity and time associated with the Maze procedure have prevented widespread application by surgeons.Recently, however, there has been increased interest in direct surgical ablation of AF, fueled by technological advances and demonstration that the pulmonary veins and left atrium are the drivers of AF in most patients. 15 New ablation technologies enable surgeons to perform pulmonary vein isolation, create strategically placed, linear left atrial lesions, and excise the left atrial appendage rapidly and safely. 16 -23 Alternate energy sources used to create lines of conduction block and replace surgical incisions of the Maze procedure include radiofrequency, microwave, ultrasound, cryothermy, and laser. 16 -25 Applied primarily in patients with valvular...

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“…Previous studies have been performed with this and other band‐type devices in a canine LAA model 12 . The canine LAA has a relatively narrow neck and does not accurately replicate the shape and variability of the LAA in humans.…”

Section: Discussionmentioning

confidence: 99%