Abstract 11638: Angiographic Efficacy of the Atriclip Left Atrial Appendage (LAA) Exclusion Device Placed by Minimally Invasive Thoracoscopic Approach
Introduction: Closure of the LAA with an endocardial device is associated with a low risk for AF related embolic stroke. The Atriclip exclusion device (Atricure, Inc., West Chester, OH, USA) allows epicardial closure of the LAA, avoiding the need for oral anticoagulation (OAC) post procedure. We sought to assess long-term LAA closure efficacy of the Atriclip applied via totally thoracoscopic (TT) approach.
Hypothesis: LAA closure efficacy will be high.
Methods: We performed a prospective CT angiography (CTA) study of all TT placed Atriclips at Vanderbilt Medical Center implanted June 13, 2011 to October 6, 2015. All subjects provided informed consent under Vanderbilt IRB approved protocol. Intra-op TEE was performed in all cases to confirm procedural success. At a minimum of 90 days postimplant, 3-D volumetric two phase CTA was performed to assess the presence of contrast leak, exposed trabeculations, residual stump and clip position. All CTA interpretation and data was obtained by chest radiologists.
Results: As of June 1, 2016, 63 patients completed CTA. The mean age was 64.8 ± 8.87 years and 77.8% were male. The majority of patients had persistent AF (82.5%). Mean CHADS2VASC score was 2.43 ± 1.44 and HASBLED was score 2.21 ± 1.23. Adequate LAA closure was defined as complete exclusion of the trabeculated LAA, which was confirmed in 59 subjects (93.6%). Cases without complete closure (n=4) include: 2 malpositioned clip not addressing a secondary LAA lobe, and 2 clips placed too distal leaving a stump with exposed trabeculae. Of the patients with complete closure, 30 (50.8%) had a smooth proximal stump. There were no major complications associated with TT placed Atriclips. Prospective follow-up over 143 observed patient-years reveals 1 stroke in a patient with documented complete LAA closure and no thrombus (hypertensive CVA).
Conclusions: Angiographic LAA closure efficacy with a TT placed Atriclip is high (93.6%). The clinical significance of a remnant stump is unknown.
Author Disclosures: N.J. Patel: None. S. Aznaurov: None. S.K. Ball: None. S.J. Hoff: None. K. Adkins: None. A. Carroll: None. J.R. Williams: None. J.J. Carr: None. K.L. Sandler: None. C.R. Ellis: Research Grant; Modest; Thoratec, Heart Ware, Boston Scientific. Consultant/Advisory Board; Modest; Sentre Heart, Spectranetics. Research Grant; Significant; Boehringer Ingelheim, Atricure Inc, Medtronic.
- © 2016 by American Heart Association, Inc.