Percutaneous Left Atrial Appendage Suture Ligation Using the LARIAT Device in Patients With Atrial Fibrillation Initial Clinical Experience

被引:278
作者
Bartus, Krzysztof [1 ]
Han, Frederick T. [2 ]
Bednarek, Jacek [3 ]
Myc, Jacek [1 ]
Kapelak, Boguslaw [1 ]
Sadowski, Jerzy [1 ]
Lelakowski, Jacek [3 ]
Bartus, Stanislaw [1 ]
Yakubov, Steven J. [4 ]
Lee, Randall J. [2 ,5 ,6 ]
机构
[1] Jagiellonian Univ, John Paul II Hosp Krakow, Dept Cardiovasc Surg & Transplantol, Krakow, Poland
[2] Univ Calif San Francisco, Dept Med, San Francisco, CA 94143 USA
[3] Jagiellonian Univ, John Paul II Hosp Krakow, Dept Electrocardiol, Krakow, Poland
[4] Riverside Methodist Hosp, Columbus, OH 43214 USA
[5] Univ Calif San Francisco, Cardiovasc Res Inst, San Francisco, CA 94143 USA
[6] Univ Calif San Francisco, Inst Regenerat Med, San Francisco, CA 94143 USA
关键词
atrial fibrillation; left atrial appendage; suture ligation; thromboembolic stroke; CORONARY-ARTERY-BYPASS; WARFARIN USE; ANTITHROMBOTIC THERAPY; STROKE PREVENTION; RISK-FACTORS; THROMBOEMBOLISM; ANTICOAGULATION; MANAGEMENT; CLOSURE; OBLITERATION;
D O I
10.1016/j.jacc.2012.06.046
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objectives The purpose of the study was to determine the efficacy and safety of left atrial appendage (LAA) closure via a percutaneous LAA ligation approach. Background Embolic stroke is the most devastating consequence of atrial fibrillation. Exclusion of the LAA is believed to decrease the risk of embolic stroke. Methods Eighty-nine patients with atrial fibrillation were enrolled to undergo percutaneous ligation of the LAA with the LARIAT device. The catheter-based LARIAT device consists of a snare with a pre-tied suture that is guided epicardially over the LAA. LAA closure was confirmed with transesophageal echocardiography (TEE) and contrast fluoroscopy immediately, then with TEE at 1 day, 30 days, 90 days, and 1 year post-LAA ligation. Results Eighty-five (96%) of 89 patients underwent successful LAA ligation. Eighty-one of 85 patients had complete closure immediately. Three of 85 patients had a <= 2-mm residual LAA leak by TEE color Doppler evaluation. One of 85 patients had a <3-mm jet by TEE. There were no complications due to the device. There were 3 access-related complications (during pericardial access, n = 2; and transseptal catheterization, n = 1). Adverse events included severe pericarditis post-operatively (n = 2), late pericardial effusion (n = 1), unexplained sudden death (n = 2), and late strokes thought to be non-embolic (n = 2). At 1 month (81 of 85) and 3 months (77 of 81) post-ligation, 95% of the patients had complete LAA closure by TEE. Of the patients undergoing 1-year TEE (n = 65), there was 98% complete LAA closure, including the patients with previous leaks. Conclusions LAA closure with the LARIAT device can be performed effectively with acceptably low access complications and periprocedural adverse events in this observational study. (C) 2012 by the American College of Cardiology Foundation
引用
收藏
页码:108 / 118
页数:11
相关论文
共 57 条
[1]   Intraprocedural and Long-Term Incomplete Occlusion of the Left Atrial Appendage Following Placement of the WATCHMAN Device: A Single Center Experience [J].
Bai, Rong ;
Horton, Rodney P. ;
Di Biase, Luigi ;
Mohanty, Prasant ;
Pump, Agnes ;
Cardinal, Deb ;
Scallon, Chantel ;
Mohanty, Sanghamitra ;
Santangeli, Pasquale ;
Brantes, Mauricio C. ;
Sanchez, Javier ;
Burkhardt, J. David ;
Zagrodzky, Jason D. ;
Gallinghouse, G. Joseph ;
Natale, Andrea .
JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, 2012, 23 (05) :455-461
[2]   Simplified technique for surgical ligation of the left atrial appendage in high-risk patients [J].
Bakhtiary, Farhad ;
Kleine, Peter ;
Martens, Sven ;
Dzemali, Omer ;
Dogan, Selami ;
Keller, Harald ;
Ackermann, Hans ;
Zierer, Andreas ;
Oezaslan, Feyzan ;
Wittlinger, Thomas ;
Moritz, Anton .
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 2008, 135 (02) :430-431
[3]   Feasibility of closed-chest ligation of the left atrial appendage in humans [J].
Bartus, Krzysztof ;
Bednarek, Jacek ;
Myc, Jacek ;
Kapelak, Boguslaw ;
Sadowski, Jerzy ;
Lelakowski, Jacek ;
Yakubov, Steven J. ;
Lee, Randall J. .
HEART RHYTHM, 2011, 8 (02) :188-193
[4]   Management of atrial fibrillation in adults: Prevention of thromboembolism and symptomatic treatment [J].
Blackshear, JL ;
Kopecky, SL ;
Litin, SC ;
Safford, RE ;
Hammill, SC .
MAYO CLINIC PROCEEDINGS, 1996, 71 (02) :150-160
[5]   Appendage obliteration to reduce stroke in cardiac surgical patients with atrial fibrillation [J].
Blackshear, JL ;
Odell, JA .
ANNALS OF THORACIC SURGERY, 1996, 61 (02) :755-759
[6]   Warfarin use following ischemic stroke among Medicare patients with atrial fibrillation [J].
Brass, LM ;
Krumholz, HM ;
Scinto, JD ;
Mathur, D ;
Radford, M .
ARCHIVES OF INTERNAL MEDICINE, 1998, 158 (19) :2093-2100
[7]   NON-RHEUMATIC ATRIAL-FIBRILLATION AS A RISK FACTOR FOR STROKE [J].
BRITTON, M ;
GUSTAFSSON, C .
STROKE, 1985, 16 (02) :182-188
[8]   Percutaneous Epicardial Left Atrial Appendage Closure: Intermediate-Term Results [J].
Bruce, Charles J. ;
Stanton, Christopher M. ;
Asirvatham, Samuel J. ;
Danielsen, Andrew J. ;
Johnson, Susan B. ;
Packer, Douglas L. ;
Friedman, Paul A. .
JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, 2011, 22 (01) :64-70
[9]   HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: Recommendations for personnel, policy, procedures and follow-up [J].
Calkins, Hugh ;
Brugada, Josep ;
Packer, Douglas L. ;
Cappato, Riccardo ;
Chen, Shih-Ann ;
Crijns, Harry J. G. ;
Damiano, Ralph J., Jr. ;
Davies, D. Wyn ;
Haines, David E. ;
Haissaguerre, Michel ;
Iesaka, Yoshito ;
Jackman, Warren ;
Jais, Pierre ;
Kottkamp, Hans ;
Kuck, Karl Heinz ;
Lindsay, Bruce D. ;
Marchlinski, Francis E. ;
McCarthy, Patrick M. ;
Mont, J. Lluis ;
Morady, Fred ;
Nademanee, Koontawee ;
Natale, Andrea ;
Pappone, Carlo ;
Prystowsky, Eric ;
Raviele, Antonio ;
Ruskin, Jeremy N. ;
Shemin, Richard J. .
HEART RHYTHM, 2007, 4 (06) :816-861
[10]   Left Atrial Appendage Occlusion: Lessons Learned From Surgical and Transcatheter Experiences [J].
Chatterjee, Subhasis ;
Alexander, John C. ;
Pearson, Paul J. ;
Feldman, Ted .
ANNALS OF THORACIC SURGERY, 2011, 92 (06) :2283-2292