Percutaneous Left Atrial Appendage Closure Using a PFO Closure Device

Kanthan, A.; Looi, Khang‐Li; Mottram, P.; Harper, Richard W.; Bittinger, L.; Alison, J.

doi:10.1016/j.hlc.2013.04.118

Cited by 4 publications

(1 citation statement)

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“…Additional endocardial LAA occlusion devices are in various stages of animal or early human trials. [36][37][38][39][40] EPICARDIAL LAA OCCLUSION DEVICES Epicardial LAA occlusion, although often more invasive, has several theoretical advantages: (1) avoiding a foreign body in contact with the blood stream that may be a nidus for thrombus or infection; (2) avoiding long-term, and often perioperative, anticoagulation; (3) avoiding LAA sizing and morphology concerns (except for the Lariat [SentreHEART, Palo Alto, Calif]); (4) consistent closure, with minimal residual LAA-to-left atrial leaks; and (5) lower device costs compared with the endocardial devices. Epicardial closure can be performed as an adjunct to concomitant cardiac procedures or as a stand-alone procedure.…”

Section: Amplatzer Cardiac Plugmentioning

confidence: 99%

Left atrial appendage exclusion: An alternative to anticoagulation in nonvalvular atrial fibrillation

Bedeir

Holmes

Cox

et al. 2017

The Journal of Thoracic and Cardiovascular Surgery

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Patients with atrial fibrillation (AF) are 5 times more likely to have a stroke than individuals in sinus rhythm, and 1 in every 5 strokes is secondary to AF. 1-3 Unfortunately, AFrelated thrombo-emboli are larger and result in ischemic strokes that are more devastating than those secondary to carotid artery disease or other etiologies. 4,5 Lifelong oral anticoagulation with warfarin has been the guidelinebased therapy to reduce the risk of AF-related ischemic strokes in patients with a CHA 2 DS 2 -VASc (congestive heart failure, hypertension, age>75 and diabetes mellitus, previous history of stroke or transient ischemic attack, vascular disease, age 65-74 years, and female sex category) score 2. Anticoagulation (AC), however, inherently predisposes to bleeding, including hemorrhagic stokes. Moreover, a significant percentage of patients with AF have relative or absolute contraindications to AC. Even those who can take it do not necessarily experience maximum anticoagulant protection. Despite demonstrating warfarin's benefit in preventing approximately one-half of AF-related strokes, the target international normalized ratio (INR) is achieved in only approximately 60% of patients despite best practices in dosing and monitoring. 6,7 A recent registry reported that among patients on warfarin for AF, only 26% were found to have a stable INR within therapeutic range. 8 The 4 major randomized controlled trials (RCTs) for nonvitamin K oral anticoagulants (NOACs) have shown the time in therapeutic range (TTR) in the warfarin-treated arms to range from 55% to 68% despite optimal dosing and INR monitoring. 9 In their meta-analysis of the 4 RCTs comparing NOACs with warfarin, Ruff et al 10 found NOACs to be superior to warfarin in reducing intracranial bleeding, but not bleeding elsewhere. Like warfarin, NOACs still subject the patient to an above-baseline predisposition to bleeding. They also both subject the patient to lifelong therapy, and despite NOACs eliminating the need for frequent blood tests, dabigatran and apixaban replace the daily warfarin dosing with a twice-daily dosing regimen. Finally, approximately 20% to 25% of patients on NOACs have discontinued the agent at 2 years of follow-up.These shortcomings of anticoagulation triggered a search for alternatives. If thrombi are identified in the left heart of patients with nonvalvular AF-related strokes, they are in the left atrial appendage (LAA) 90% of the time. 11 This observation led to an increased interest in closing the LAA mechanically as a potential means of reducing the stroke rate in patients with nonvalvular AF. Successful LAA occlusion can potentially provide patients who cannot tolerate OAC therapy a means of stroke risk reduction, and to spare those who can receive OAC the potential hazards, inconveniences and costs of lifelong anticoagulation. In this review, we discuss techniques and devices aimed at LAA exclusion. LAA OCCLUSION OR EXCISIONThe first known attempt at occluding or excising the LAA to prevent stroke was reported in 1949 and the outco...

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Section: Amplatzer Cardiac Plugmentioning

confidence: 99%

Left atrial appendage exclusion: An alternative to anticoagulation in nonvalvular atrial fibrillation

Bedeir

Holmes

Cox

et al. 2017

The Journal of Thoracic and Cardiovascular Surgery

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Left Atrial Appendage Exclusion for Prevention of Stroke in Atrial Fibrillation: Review of Minimally Invasive Approaches

Moss

2014

Curr Cardiol Rep

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Stroke prevention is of vital importance in the management of atrial fibrillation (AF), though the proven strategy of systemic anticoagulation for thromboembolic prophylaxis is underutilized for a variety of reasons. The left atrial appendage (LAA) has long been suspected as the principal source of arterial emboli, particularly in nonvalvular AF, and a variety of techniques for its exclusion from the circulation have been developed. This review highlights the history of the LAA as a target of intervention, and the parallel advances in three minimally invasive strategies for its exclusion: percutaneous occlusion of the LAA orifice from within the left atrium, closed-chest ligation via a percutaneous pericardial approach, and minimally invasive thoracoscopic surgery. While further study is necessary, available evidence suggests that effective LAA exclusion is becoming a viable alternative to anticoagulation for stroke prevention in nonvalvular AF.

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Percutaneous Transcatheter Left Atrial Appendage Closure Devices: Role in the Long-Term Management of Atrial Fibrillation

Gan

Bhat

Davis

et al. 2014

Heart, Lung and Circulation

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Percutaneous Left Atrial Appendage Closure Using a PFO Closure Device

Cited by 4 publications

References 0 publications

Left atrial appendage exclusion: An alternative to anticoagulation in nonvalvular atrial fibrillation

Left atrial appendage exclusion: An alternative to anticoagulation in nonvalvular atrial fibrillation

Left Atrial Appendage Exclusion for Prevention of Stroke in Atrial Fibrillation: Review of Minimally Invasive Approaches

Percutaneous Transcatheter Left Atrial Appendage Closure Devices: Role in the Long-Term Management of Atrial Fibrillation

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