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  • 1
    Online Resource
    Online Resource
    The CT derived angle between the transseptal puncture site and the left atrial appendage as a predictor for complex interventional occlusion procedures
    Wiley ; 2023
    In:  Echocardiography
    Details
    In: Echocardiography, Wiley
    Abstract: To evaluate the role of the CT‐derived angle between the intra‐atrial septum (IAS) and the left atrial appendage (LAA) on procedural complexity and clinical outcomes in left atrial appendage occlusion (LAAO) procedures. Background Given the broad variations in anatomy, LAAO remains one of the most challenging interventional procedures in structural heart disease. In recent years, preprocedural cardiac tomography (CT) has evolved as a valuable tool; however, prediction of procedural complexity remains cumbersome. Methods We retrospectively analyzed 47 patients that underwent LAAO at our center in whom pre‐procedural cardiac CT‐scans were available. Among other baseline parameters, we measured the angle between the LAA ostium and the preferred transseptal puncture site at the IAS. We compared patients with an angle above and below the median regarding procedural characteristics and procedural outcome. Results The median angle between the LAA and the IAS was 127.3° (IQR: 120.9–141.3). LAAO took longer in patients with a measured angle below the median (55.0 ± 22.7 min vs. 41.3 ± 17.5 min; p  = .04), resulting in longer radiation times (13.0 ± 5.3 min vs. 9.8 ± 5.7 min; p  = .04) and more contrast use (61.1 ± 47.5 mL vs. 33.6 ± 24.7 mL; p  = .05). Moreover, the necessity for a sheath exchange was significantly higher (30.4% vs. 4.2%, p  = .02) and device repositioning or device resizing trended to be more frequent (26.1% vs. 8.3%; p  = .1 and 21.7% vs. 8.3%; p  = .2). There were no differences in procedural outcome, device‐position and peri‐device leak (PDL). Conclusions The angle between the transseptal puncture site and the LAA ostium may serve as a predictor for more demanding LAAO interventions. In our study a steeper angle led to a prolonged procedure resulting in higher doses of contrast and radiation, but was not associated with a worse procedural outcome.
    Type of Medium: Online Resource
    ISSN: 0742-2822 , 1540-8175
    URL: Article
    DOI: 10.1111/echo.15699
    Language: English
    Publisher: Wiley
    Publication Date: 2023
    detail.hit.zdb_id: 2041033-5
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  • 2
    Online Resource
    Online Resource
    Mechanical properties of currently available left atrial appendage occlusion devices: A bench‐testing analysis
    Wiley ; 2019
    In:  Artificial Organs Vol. 43, No. 7 ( 2019-07), p. 656-665
    Details
    In: Artificial Organs, Wiley, Vol. 43, No. 7 ( 2019-07), p. 656-665
    Abstract: Endoluminal left atrial appendage occlusion is an emerging therapy to treat patients suffering from atrial fibrillation with contraindications against oral anticoagulation. Different occlusion devices have been introduced into the clinical setting while comparative studies between the devices are sparse. This in vitro study compares several endoluminal left atrial appendage occlusion systems regarding 2 mechanical properties: radial (RF) and tug force (TF). Seven different occluder systems of various sizes (24 in total) underwent testing throughout their recommended sizing range. RF was measured in a commercial RF tester. TF was assessed according to a recently published bench test. RF increased with compression of the devices: The LAmbre 2228 device exerted the highest RF (8.6 N) at maximum compression of 16 mm. The lowest RF of 0.1 N was exhibited by the 27 mm Occlutech occluder at minimal compression. The highest TFs were exerted by the WaveCrest devices at maximum compression with 4.6 and 3.6 N for the 22 mm and the 27 mm device, respectively. The lowest TFs were measured for the first‐generation Occlutech devices, particularly for the 24 mm device with 1.1 N at maximum compression and 0.4 N at minimum compression. A strong positive correlation was found between the number of hooks per millimeter circumference of an occluder and its tug force ( r  = 0.87, P   〈  0.01). The analysis revealed device stability to be more dependent on anchoring structures than on RF. The wide range of mechanical properties makes comparison of current LAA occluders difficult and emphasizes the need for standardized preclinical testing to prompt clinical compatibility.
    Type of Medium: Online Resource
    ISSN: 0160-564X , 1525-1594
    URL: Issue
    URL: Article
    DOI: 10.1111/aor.2019.43.issue-7
    DOI: 10.1111/aor.13414
    Language: English
    Publisher: Wiley
    Publication Date: 2019
    detail.hit.zdb_id: 2003825-2
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  • 3
    Online Resource
    Online Resource
    Incidence, persistence, and clinical relevance of iatrogenic atrial septal defects after percutaneous left atrial appendage occlusion
    Wiley ; 2022
    In:  Echocardiography Vol. 39, No. 1 ( 2022-01), p. 65-73
    Details
    In: Echocardiography, Wiley, Vol. 39, No. 1 ( 2022-01), p. 65-73
    Abstract: To investigate the rate and clinical impact of a persisting iatrogenic atrial septal defect (iASD) after percutaneous left atrial appendage occlusion (LAAO). Background Percutaneous LAAO is an alternative to oral anticoagulation (OAC) for the prevention of ischemic stroke and systemic embolism in patients with atrial fibrillation (AF). Data regarding incidence and persistence of iASD after LAAO procedures and its clinical relevance is scarce. Methods We retrospectively analyzed 144 patients that underwent LAAO at our center between 2009 and 2020 who had at least one follow‐up including transesophageal echocardiography (TEE). Baseline clinical, procedural data and echocardiographic characteristics in patients with and without evidence of an iASD were compared. We furthermore determined the rate of iASD persistence over time and evaluated outcomes of patients with and without spontaneous iASD closure. Results After a median of 92 days (IQR 75–108 days) after LAAO, 50 patients (50/144, 34.7%) showed evidence of an iASD. Patients with iASD had higher CHADS‐VASc‐scores (4.9±1.5 vs 4.2±1.2, p  = 0.03), larger left atrial volumes (80.5±30.5 ml vs 67.1±19.7 ml, p  = 0.01) and were more likely to have relevant mitral regurgitation (≥° II) (46.0% vs 12.3%, p  = 0.001). LAAO procedures took longer (50.1±24.3 vs 41.1±17.8 min, p  = 0.06) in patients with a persisting iASD. Furthermore, larger device sizes were implanted (24.3±3.4 mm vs 22.1±2.8 mm, p  = 0.03). The presence of an iASD had no impact on RV dysfunction, thromboembolism or mortality. Spontaneous closure of an iASD was documented in 52.0% (26/50). Hereby, similar risk factors were identified for the persistence of an iASD in follow‐up.
    Type of Medium: Online Resource
    ISSN: 0742-2822 , 1540-8175
    URL: Issue
    URL: Article
    DOI: 10.1111/echo.v39.1
    DOI: 10.1111/echo.15271
    Language: English
    Publisher: Wiley
    Publication Date: 2022
    detail.hit.zdb_id: 2041033-5
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