Zakaria Jalal1, Xavier Iriart2, Marie-Lou Dinet2, Jean-Bernard Selly2, Nadir Tafer2, Pauline Renou3, Igor Sibon3, Jean-Benoît Thambo4. 1. Department of Paediatric and Adult Congenital Cardiology, University Hospital of Bordeaux, 33000 Bordeaux, France. Electronic address: jalalzakaria1@gmail.com. 2. Department of Paediatric and Adult Congenital Cardiology, University Hospital of Bordeaux, 33000 Bordeaux, France. 3. Department of Neurology, University Hospital of Bordeaux, 33000 Bordeaux, France. 4. Department of Paediatric and Adult Congenital Cardiology, University Hospital of Bordeaux, 33000 Bordeaux, France; Inserm 1045, University of Bordeaux, 33000 Bordeaux, France.
Abstract
BACKGROUND: Percutaneous left atrial appendage (LAA) closure has emerged as an alternative therapeutic option for the prevention of embolic stroke in high-risk patients with non-valvular atrial fibrillation. The presence of thrombus in the LAA is currently a contraindication to the procedure. AIM: To describe a modified LAA closure technique that allows a safe procedure in patients with LAA thrombus. METHODS: Between May 2013 and October 2014, LAA closure was performed in three patients with LAA thrombus (mean age 73.6±14 years; two men), using a modified technique that avoids manipulation of catheters or angiography in the LAA. RESULTS: Two patients had persistent thrombus despite appropriate antithrombotic therapy, while the other patient had a contraindication to systemic anticoagulation. The procedure was successful using the modified implantation technique in all patients. The implanted device was the AMPLATZER™ Cardiac Plug (St. Jude Medical, Minneapolis, MN, USA) in one patient and the Amulet™ (St. Jude Medical, Minneapolis, MN, USA) in two patients. No periprocedural complications occurred. After a mean follow-up of 8±2 months, no deaths or late complications were observed. CONCLUSIONS: Thrombus trapping is a feasible and effective technique for performing LAA occlusion in patients with thrombus within the LAA. This modification of the implantation technique may allow LAA closure indications to be extended to include patients with LAA thrombus, who were formerly considered unsuitable.
BACKGROUND: Percutaneous left atrial appendage (LAA) closure has emerged as an alternative therapeutic option for the prevention of embolic stroke in high-risk patients with non-valvular atrial fibrillation. The presence of thrombus in the LAA is currently a contraindication to the procedure. AIM: To describe a modified LAA closure technique that allows a safe procedure in patients with LAA thrombus. METHODS: Between May 2013 and October 2014, LAA closure was performed in three patients with LAA thrombus (mean age 73.6±14 years; two men), using a modified technique that avoids manipulation of catheters or angiography in the LAA. RESULTS: Two patients had persistent thrombus despite appropriate antithrombotic therapy, while the other patient had a contraindication to systemic anticoagulation. The procedure was successful using the modified implantation technique in all patients. The implanted device was the AMPLATZER™ Cardiac Plug (St. Jude Medical, Minneapolis, MN, USA) in one patient and the Amulet™ (St. Jude Medical, Minneapolis, MN, USA) in two patients. No periprocedural complications occurred. After a mean follow-up of 8±2 months, no deaths or late complications were observed. CONCLUSIONS:Thrombus trapping is a feasible and effective technique for performing LAA occlusion in patients with thrombus within the LAA. This modification of the implantation technique may allow LAA closure indications to be extended to include patients with LAA thrombus, who were formerly considered unsuitable.
Authors: Luis Marroquin; Gabriela Tirado-Conte; Radosław Pracoń; Witold Streb; Hipolito Gutierrez; Giacomo Boccuzzi; Dabit Arzamendi-Aizpurua; Ignacio Cruz-González; Juan Miguel Ruiz-Nodar; Jung-Sun Kim; Xavier Freixa; Jose Ramon Lopez-Minguez; Ole De Backer; Rafael Ruiz-Salmeron; Antonio Dominguez; Angela McInerney; Vicente Peral; Rodrigo Estevez-Loureiro; Eduard Fernandez-Nofrerias; Afonso B Freitas-Ferraz; Francesco Saia; Zenon Huczek; Livia Gheorghe; Pablo Salinas; Marcin Demkow; Jose R Delgado-Arana; Estefania Fernandez Peregrina; Zbibniew Kalarus; Ana Elvira Laffond; Yangsoo Jang; Jose Carlos Fernandez Camacho; Oh-Hyun Lee; Jose M Hernández-Garcia; Caterina Mas-Llado; Berenice Caneiro Queija; Ignacio J Amat-Santos; Maciej Dabrowski; Josep Rodés-Cabau; Luis Nombela Franco Journal: Heart Date: 2022-06-24 Impact factor: 7.365