A novel device for left atrial appendage exclusion

被引:29
作者
Kamohara, K
Fukamachi, K
Ootaki, Y
Akiyama, M
Zahr, F
Kopcak, MW
Dessoffy, R
Popovic, ZB
Daimon, M
Cosgrove, DM
Gillinov, AM
机构
[1] Cleveland Clin Fdn, Dept Biomed Engn, Lerner Res Inst, Cleveland, OH 44195 USA
[2] Cleveland Clin Fdn, Dept Cardiovasc Med, Cleveland, OH 44195 USA
[3] Cleveland Clin Fdn, Dept Thorac & Cardiovasc Surg, Cleveland, OH 44195 USA
关键词
D O I
10.1016/j.jtcvs.2005.08.019
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective: The left atrial appendage is a frequent source of thromboemboli in patients with atrial fibrillation. Exclusion or excision of the left atrial appendage may reduce the risk of stroke in patients with atrial fibrillation. We evaluated the ability of a novel device to exclude the left atrial appendage during early and intermediate follow-up periods in a canine model. Methods: Eight mongrel dogs (mean weight 29.1 +/- 4.0 kg) were used in this study. The occlusion device, constructed from 2 stainless steel strips covered with a knit braided polyester fabric, was implanted at the base of the left atrial appendage through a left thoracotomy on a beating heart. Dogs were evaluated at 7 days (n = 2), 30 days (n = 2), and 90 days (n = 4) by epicardial echocardiography, left atrial angiography, histologic inspection, and gross pathology. Results: Device implantation was performed without complications in all animals. Complete exclusion of the left atrial appendage from the circulation was confirmed acutely and chronically by echocardiographic and angiographic evaluations. There was no device migration or damage to adjacent structures. Conclusion: This novel device enables rapid, reliable, and safe exclusion of the left atrial appendage. The device provides a new therapeutic option for reducing the risk of stroke in patients with atrial fibrillation.
引用
收藏
页码:1639 / 1644
页数:6
相关论文
共 25 条
[1]   Left atrial appendage: structure, function, and role in thromboembolism [J].
Al-Saady, NM ;
Obel, OA ;
Camm, AJ .
HEART, 1999, 82 (05) :547-554
[2]   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
[3]   ACC/AHA guidelines for the management of patients with valvular heart disease - A report of the American College of Cardiology American Heart Association Task Force on practice guidelines (Committee on Management of Patients with Valvular Heart Disease) [J].
Bonow, RO ;
Carabello, B ;
De Leon, AC ;
Edmunds, LH ;
Fedderly, BJ ;
Freed, MD ;
Gaasch, WH ;
Mckay, CR ;
Nishimura, RA ;
O'Gara, PT ;
O'Rourke, RA ;
Rahimtoola, SH .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1998, 32 (05) :1486-1582
[4]   Left Atrial Appendage Occlusion Study (LAAOS): A randomixed clinical trial of left atrial appendage occlusion during routine coronary artery bypass graft surgery for long-term stroke prevention [J].
Crystal, E ;
Lamy, A ;
Connolly, SJ ;
Kleine, P ;
Hohnloser, SH ;
Semelhago, L ;
Abouzhar, L ;
Cybulsky, I ;
Shragge, B ;
Teoh, K ;
Lonn, E ;
Sawchuk, C ;
Oezaslan, F .
AMERICAN HEART JOURNAL, 2003, 145 (01) :174-178
[5]   LIGATION OF THE LEFT ATRIAL APPENDAGE USING AN AUTOMATIC SURGICAL STAPLER [J].
DISESA, VJ ;
TAM, S ;
COHN, LH .
ANNALS OF THORACIC SURGERY, 1988, 46 (06) :652-653
[6]   Large gradient across a partially ligated left atrial appendage [J].
Fisher, DC ;
Tunick, PA ;
Kronzon, I .
JOURNAL OF THE AMERICAN SOCIETY OF ECHOCARDIOGRAPHY, 1998, 11 (12) :1163-1165
[7]   Validation of clinical classification schemes for predicting stroke - Results from the national registry of Atrial Fibrillation [J].
Gage, BF ;
Waterman, AD ;
Shannon, W ;
Boechler, M ;
Rich, MW ;
Radford, MJ .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2001, 285 (22) :2864-2870
[8]   Role of left atrial appendage obliteration in stroke reduction in patients with mitral valve prosthesis -: A transesophageal echocardiographic study [J].
García-Fernández, MA ;
Pérez-David, E ;
Quiles, J ;
Peralta, J ;
García-Rojas, I ;
Bermejo, J ;
Moreno, M ;
Silva, J .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2003, 42 (07) :1253-1258
[9]   Stapled excision of the left atrial appendage [J].
Gillinov, AM ;
Pettersson, G ;
Cosgrove, DM .
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 2005, 129 (03) :679-680
[10]   Left atrial structure and function after percutaneous left atrial appendage transcatheter occlusion (PLAATO) - Six-month echocardiographic follow-up [J].
Hanna, IR ;
Kolm, P ;
Martin, R ;
Reisman, M ;
Gray, W ;
Block, PC .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2004, 43 (10) :1868-1872