Lisheng Jiang1, Erich Duenninger2, Manuela Muenzel2, Xin Xue3, Adam Fazakas2, Thorsten Keil4, Jiangtao Yu5. 1. Department of Cardiology, Helmut-G.-Walther-Klinikum, 96215, Lichtenfels, Germany; Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China. 2. Department of Cardiology, Helmut-G.-Walther-Klinikum, 96215, Lichtenfels, Germany. 3. Department of Cardiology, Helmut-G.-Walther-Klinikum, 96215, Lichtenfels, Germany; Department of Cardiology, the Second Hospital, Jilin University, Changchun, China. 4. Department of Anesthesiology, Helmut-G.-Walther-Klinikum, Lichtenfels, Germany. 5. Department of Cardiology, Helmut-G.-Walther-Klinikum, 96215, Lichtenfels, Germany. Electronic address: jiangtao.yu@klinikum-lichtenfels.de.
Abstract
BACKGROUND: Left atrial appendage closure (LAAC) is an efficient alternative of oral anticoagulation to prevent stroke in patients with non-valvular atrial fibrillation (NVAF). Due to complexities of LAA anatomy, a complete closure may not always be obtained with a single device. The aim of this study was to evaluate the feasibility and safety of the staged 'kissing-Watchman' technology to occlude the LAA with complex anatomy. METHODS: In our center, among 300 cases underwent LAAC with Watchman device from February 2012 to December 2016, 7 complex LAAs were implanted double devices using the staged 'kissing-Watchman' technology. The anatomic morphology, procedure characteristics and safety were analyzed. RESULTS: Of the 7 LAAs, the anatomic morphology includes 6 cauliflowers and 1 chicken wings, each has 2 big lobes and a large common ostium. In the two-staged LAAC procedures, there were no differences in X-ray exposure time, but the total procedure time (p = 0.0634), contrast volume (p = 0.0802) and X-ray dose (p = 0.0803) in the first procedure showed a tendency over the second. All the procedures were successful, except for one case with a 2 mm of peri-device leakage, there were no severe complications or major adverse events including device dislocation, thrombosis, obvious peri-device leakage (≥5 mm), pericardial effusion/tamponade, stroke/transient ischemic attack/systemic embolism, death and major bleeding during the 7-day perioperative period and the 6-month follow-up. CONCLUSIONS: The staged 'kissing-Watchman' technology is feasible and safe, which might provide a strategy to occlude the LAA with complex anatomy when an incomplete closure is inevitable with a single device.
BACKGROUND: Left atrial appendage closure (LAAC) is an efficient alternative of oral anticoagulation to prevent stroke in patients with non-valvular atrial fibrillation (NVAF). Due to complexities of LAA anatomy, a complete closure may not always be obtained with a single device. The aim of this study was to evaluate the feasibility and safety of the staged 'kissing-Watchman' technology to occlude the LAA with complex anatomy. METHODS: In our center, among 300 cases underwent LAAC with Watchman device from February 2012 to December 2016, 7 complex LAAs were implanted double devices using the staged 'kissing-Watchman' technology. The anatomic morphology, procedure characteristics and safety were analyzed. RESULTS: Of the 7 LAAs, the anatomic morphology includes 6 cauliflowers and 1 chicken wings, each has 2 big lobes and a large common ostium. In the two-staged LAAC procedures, there were no differences in X-ray exposure time, but the total procedure time (p = 0.0634), contrast volume (p = 0.0802) and X-ray dose (p = 0.0803) in the first procedure showed a tendency over the second. All the procedures were successful, except for one case with a 2 mm of peri-device leakage, there were no severe complications or major adverse events including device dislocation, thrombosis, obvious peri-device leakage (≥5 mm), pericardial effusion/tamponade, stroke/transient ischemic attack/systemic embolism, death and major bleeding during the 7-day perioperative period and the 6-month follow-up. CONCLUSIONS: The staged 'kissing-Watchman' technology is feasible and safe, which might provide a strategy to occlude the LAA with complex anatomy when an incomplete closure is inevitable with a single device.
Authors: Tao Chen; Qing-Song Wang; Ge Liu; Xu Lu; Ting-Ting Song; Ming-Yuan Shi; Hang Zhu; Yang Mu; Jun Guo; Yun-Dai Chen Journal: Front Cardiovasc Med Date: 2022-03-22