Dhanunjaya Lakkireddy1, Muhammad R Afzal2, Randall J Lee3, Hosakote Nagaraj4, David Tschopp5, Brett Gidney6, Christopher Ellis7, Eric Altman8, Brian Lee9, Saibal Kar10, Nitish Bhadwar3, Mauricio Sanchez11, Varuna Gadiyaram12, Rudolph Evonich12, Abdi Rasekh13, Jie Cheng14, Frank Cuoco15, Sheetal Chandhok16, Sampath Gunda2, Madhu Reddy2, Donita Atkins2, Sudharani Bommana2, Phillip Cuculich17, Douglas Gibson4, Jayant Nath2, Ryan Ferrell2, Earnest Matthew2, David Wilber18. 1. Division of Cardiovascular Diseases, Cardiovascular Research Institute, Kansas City, Kansas. Electronic address: dlakkireddy@kumc.edu. 2. Division of Cardiovascular Diseases, Cardiovascular Research Institute, Kansas City, Kansas. 3. Division of Cardiology, Section of Cardiac Electrophysiology, University of San Francisco and Cardiovascular Research Institute, San Francisco, California. 4. Nebraska Heart Institute, Lincoln, Nebraska. 5. Heart Hospital of Austin, Austin, Texas. 6. Heart Rhythm Center, Santa Barbara, California. 7. Vanderbilt University Medical Center, Nashville, Tennessee. 8. North Shore University Hospital, Manhasset, New York. 9. Texas Health Presbyterian Hospital, Dallas, Texas. 10. Cedars Sinai, Los Angeles, California. 11. Mercy Hospital, St. Louis, Missouri. 12. Scripps Health, San Diego, California. 13. Hall-Garcia Cardiology Associates, Houston, Texas. 14. University of Texas, Houston, Texas; Texas Heart Institute, St. Lukes Hospital, Houston, Texas. 15. Medical University of South Carolina, Charleston, South Carolina. 16. Bryn Mawr Med Associates-Cardiology, Bryn Mawr, Pennsylvania. 17. Washington University, St. Louis, Missouri. 18. Loyola University Medical Center, Maywood, Illinois.
Abstract
BACKGROUND: Published studies of epicardial ligation of left atrial appendage (LAA) have reported discordant results. OBJECTIVE: The purpose of this study was to delineate the safety and efficacy of LAA closure with the LARIAT device. METHODS: This is a multicenter registry of 712 consecutive patients undergoing LAA ligation with LARIAT at 18 US hospitals. The primary end point was successful suture deployment, no leak by intraprocedural transesophageal echocardiography (TEE), and no major complication (death, stroke, cardiac perforation, and bleeding requiring transfusion) at discharge. A leak of 2-5 mm on follow-up TEE was the secondary end point. RESULTS: LARIAT was successfully deployed in 682 patients (95.5%). A complete closure was achieved in 669 patients (98%), while 13 patients (1.8%) had a trace leak (<2 mm). There was 1 death related to the procedure. Ten patients (1.44%) had cardiac perforation necessitating open heart surgery, while another 14 (2.01%) did not need surgery. The risk of cardiac perforation decreased significantly after the introduction of a micropuncture (MP) needle for pericardial access. Delayed complications (pericarditis requiring >2 weeks of treatment with nonsteroidal anti-inflammatory drugs/colchicine and pericardial and pleural effusion after discharge) occurred in 34 (4.78%) patients, and the risk decreased significantly with the periprocedural use of colchicine. Follow-up TEE (n = 480) showed a leak of 2-5 mm in 6.5% and a thrombus in 2.5%. One patient had a leak of >5 mm. CONCLUSION: LARIAT effectively closes the LAA and has acceptable procedural risks with the evolution of the use of the micropuncture needle for pericardial access and the use of colchicine for mitigating the postinflammatory response associated with LAA ligation and pericardial access.
BACKGROUND: Published studies of epicardial ligation of left atrial appendage (LAA) have reported discordant results. OBJECTIVE: The purpose of this study was to delineate the safety and efficacy of LAA closure with the LARIAT device. METHODS: This is a multicenter registry of 712 consecutive patients undergoing LAA ligation with LARIAT at 18 US hospitals. The primary end point was successful suture deployment, no leak by intraprocedural transesophageal echocardiography (TEE), and no major complication (death, stroke, cardiac perforation, and bleeding requiring transfusion) at discharge. A leak of 2-5 mm on follow-up TEE was the secondary end point. RESULTS: LARIAT was successfully deployed in 682 patients (95.5%). A complete closure was achieved in 669 patients (98%), while 13 patients (1.8%) had a trace leak (<2 mm). There was 1 death related to the procedure. Ten patients (1.44%) had cardiac perforation necessitating open heart surgery, while another 14 (2.01%) did not need surgery. The risk of cardiac perforation decreased significantly after the introduction of a micropuncture (MP) needle for pericardial access. Delayed complications (pericarditis requiring >2 weeks of treatment with nonsteroidal anti-inflammatory drugs/colchicine and pericardial and pleural effusion after discharge) occurred in 34 (4.78%) patients, and the risk decreased significantly with the periprocedural use of colchicine. Follow-up TEE (n = 480) showed a leak of 2-5 mm in 6.5% and a thrombus in 2.5%. One patient had a leak of >5 mm. CONCLUSION: LARIAT effectively closes the LAA and has acceptable procedural risks with the evolution of the use of the micropuncture needle for pericardial access and the use of colchicine for mitigating the postinflammatory response associated with LAA ligation and pericardial access.
Authors: Thomas Fink; Michael Schlüter; Roland Richard Tilz; Christian-Hendrik Heeger; Christine Lemes; Tilmann Maurer; Bruno Reissmann; Laura Rottner; Francesco Santoro; Shibu Mathew; Andreas Rillig; Feifan Ouyang; Karl-Heinz Kuck; Andreas Metzner Journal: Clin Res Cardiol Date: 2018-06-07 Impact factor: 5.460
Authors: Etem Caliskan; James L Cox; David R Holmes; Bernhard Meier; Dhanunjaya R Lakkireddy; Volkmar Falk; Sacha P Salzberg; Maximilian Y Emmert Journal: Nat Rev Cardiol Date: 2017-08-10 Impact factor: 32.419