Abstract 4288: Transcatheter Patch Occlusion of the Left Atrial Appendage in High Risk for Stroke Patients With Atrial Fibrillation
Background: The left atrial appendage (LAA) is the most common site of thrombus formation in patients with atrial fibrillation; therefore LAA obliteration could prevent embolic strokes. The Transcatheter Patch (TP) is a frameless, bio-absorbable, balloon deliverable device which can be adjusted for the shape and size of the appendage without the risk of perforation.
Method: LAA occlusion was performed in fifteen high risk patients, 59 – 89 years old, with atrial fibrillation. Measurement of the LAA mouth revealed diameters between 15 and 20 mm. The LAA was entered after transeptal puncture and the device was introduced through a 13F Mullins sheath. A two stage poly-ethylene glycol surgical adhesive was applied to the distal half of the device. Activation of the adhesive was achieved by direct injection of alkaline solution and the device was released in 45 minutes. Fluoroscopy and transesophageal echocardiography (TEE) were used for device placement. Follow-up TEE was performed upon discharge.
Results: The procedure was successful in all cases except one, where the patch was retrieved through the introducing sheath for technical reasons. All other patients had their appendage occluded. In one case, the patch was placed beyond the mouth of the appendage, resulting in a residual opening. There was further improvement of the occlusion rate on the follow-up TEE. There were no complications related to the procedure and no thrombus formation. No recurrent strokes were reported.
Conclusions: LAA occlusion by the TP is effective and safe in high risk for embolic stroke patients with atrial fibrillation. The unique design of this balloon deliverable device proved ideal for LAA occlusion. The procedure is simple and in order to achieve full occlusion, it is important to position the device at the mouth of the appendage. Continuation of the high risk registry and initiation of a prospective randomized to anticoagulation study are justified.