Post-Mortem Analysis of a Left Atrial Appendage Occlusion Device (PLAATO™) in a Patient with Permanent Atrial Fibrillation

Park, Jai Wun; Gerk, U.; Franke, Ralf-Peter; Jung, F.

doi:10.1159/000149574

Cited by 12 publications

(9 citation statements)

References 18 publications

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“…Results in dogs and patients were similar to an earlier device that did not complete large-scale development (Percutaneous Left Atrial Appendage Transcatheter Occlusions [PLAATO] device, ev3, Plymouth, Minnesota) (19,20). Results in dogs and patients were similar to an earlier device that did not complete large-scale development (Percutaneous Left Atrial Appendage Transcatheter Occlusions [PLAATO] device, ev3, Plymouth, Minnesota) (19,20).…”

Section: Discussionsupporting

confidence: 60%

Left Atrial Appendage Obliteration

Schwartz

Holmes

Tassel

et al. 2010

JACC: Cardiovascular Interventions

138

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Section: Discussionsupporting

confidence: 60%

Left Atrial Appendage Obliteration

Schwartz

Holmes

Tassel

et al. 2010

JACC: Cardiovascular Interventions

138

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show abstract

“…Nevertheless, there are conflicting results concerning formation of neo-endothelium on the device, which is the prerequisite to absence of thrombogenicity. Post mortem analysis by Omran et al198) demonstrated a PLAATO device completely covered by neoendothelium on the atrial surface one year after implantation, whereas we found no endothelialization of the luminal side 2.5 years after LAA occlusion 199)…”

Section: Left Atrial Appendage Occlusion For Stroke Risk Reductioncontrasting

confidence: 57%

Cardioembolic Stroke in Atrial Fibrillation-Rationale for Preventive Closure of the Left Atrial Appendage

Leithäuser

Park

2009

Korean Circ J

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Atrial fibrillation is the most common cardiac arrhythmias, and a major cause of morbidity and mortality due to cardioembolic stroke. The left atrial appendage is the major site of thrombus formation in non-valvular atrial fibrillation. Loss of atrial systole in atrial fibrillation and increased relative risk of associated stroke point strongly toward a role for stasis of blood in left atrial thrombosis, although thrombus formation is multifactorial, and much more than blood flow irregularities are implicated. Oral anticoagulation with vitamin-K-antagonists is currently the most effective prophylaxis for stroke in atrial fibrillation. Unfortunately, this treatment is often contraindicated, particularly in the elderly, in whom risk of stroke is high. Moreover, given the risk of major bleeding, there is reason to be skeptical of the net benefit when warfarin is used in those patients. This work reviews the pathophysiology of cardioembolic stroke and critically spotlights the current status of preventive anticoagulation therapy. Various techniques to exclude the left atrial appendage from circulation were discussed as a considerable alternative for stroke prophylaxis.

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“…Moreover, the lack of atrial side surface endotheliazation more than two years after device implantation was shown by our group [93]. An immunofluorescent visualization of endothelial cells on a post mortem explanted PLAATO device revealed a complete endothelial layer on the adjacent atrial endocardium, but only singular endothelial cells on the polytetrafluoroethylene (PTFE) membrane surface [93]. Thus, the adherence of plasma proteins and platelets to both PTFE and nitinol [101,106,116,118,125] may promote thrombus formation on the surface of an occluding device, resulting in cardiac embolism despite LAA occlusion.…”

Section: Left Atrial Appendage Occlusion For Stroke Risk Reductionmentioning

confidence: 51%

“…Those thrombi may be washed out by repeated injections of contrast dye with subsequent inflation of the LAA and can cause embolic transient cerebral ischemia or stroke. Moreover, the lack of atrial side surface endotheliazation more than two years after device implantation was shown by our group [93]. An immunofluorescent visualization of endothelial cells on a post mortem explanted PLAATO device revealed a complete endothelial layer on the adjacent atrial endocardium, but only singular endothelial cells on the polytetrafluoroethylene (PTFE) membrane surface [93].…”

Section: Left Atrial Appendage Occlusion For Stroke Risk Reductionmentioning

confidence: 93%

Rheological and hemostasiological aspects of thrombus formation in the left atrial appendage in atrial fibrillation? A new strategy for prevention of cardioembolic stroke

Leithäuser

Jung

Park

2010

Clinical Hemorheology and Microcirculation

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Atrial fibrillation (AF), as the most common cardiac rhythm disturbance, gains in importance not only for the persons affected, but also for health care and social economy due to thromboembolic events, of which stroke is the most serious, disabling, and life threatening one. Cardiac embolism is due to thrombus formation mainly in the left atrial appendage (LAA). The pathophysiology leading to increased thrombogenicity is complex and requires a remodelling of the LAA structure, decreased LAA blood flow, activation of inflammatory processes, deviations of the hemostatic/fibrinolytic system, and activation/dysfunction of endothelial/endocardial cells. Altogether, a prothrombotic state proposed by Virchow more than 150 years ago. The presence of a LAA thrombus, therefore, is a result of a dynamic process of clot formation and lysis. A comprehensive understanding of this pathophysiology is helpful to optimize the management of patients at high risk of cardioembolic stroke. Especially those with contraindications for oral anticoagulation are in a need of an alternative approach that is not associated with a long-term risk of hemorrhage and other attendant circumstances. The reasonable alternative may be the exclusion of the LAA cavity from circulation by either surgical or percutaneous catheter-based procedures. B. Leithäuser et al. / A new strategy for prevention of cardioembolic stroke113]. There is a fivefold increased risk of stroke and thromboembolism with AF when compared to sinus rhythm [128]. On the assumption that more than 90% of all cardiac thrombi in patients with AF form in the LAA, and the fact that thrombi have been identified in 15-20% of patients with AF who have clinical risk factors for ischemic stroke [8,119], it has been deemed to be "our most lethal attachment" [60].The mechanism of thrombus formation in the LAA with subsequent embolization is undoubtedly complex. It requires a combination of abnormal blood stasis, endothelial or endocardial dysfunction and an activated state of the coagulation system, thus reflecting a pathophysiology proposed by Rudolf Virchow in 1856 and named as Virchow's triad for thrombogenesis [19].Although the incidence of thromboembolism in atrial fibrillation can be dramatically reduced with the use of anticoagulants, particularly warfarin [44,50], this option continues to be underused, even in eligible patients [16,43,45,49]. Obliteration or amputation of the LAA may help to reduce the risk of thromboembolism [8,86], above all in patients with an equally high risk of stroke and bleeding [28,36,58,74].

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Post-Mortem Analysis of a Left Atrial Appendage Occlusion Device (PLAATO™) in a Patient with Permanent Atrial Fibrillation

Cited by 12 publications

References 18 publications

Left Atrial Appendage Obliteration

Left Atrial Appendage Obliteration

Cardioembolic Stroke in Atrial Fibrillation-Rationale for Preventive Closure of the Left Atrial Appendage

Rheological and hemostasiological aspects of thrombus formation in the left atrial appendage in atrial fibrillation? A new strategy for prevention of cardioembolic stroke

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