Preliminary Experimental Study of a Novel Device for Left Atrial Appendage Closure_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHENGShuai , ZHANGHai-bo , LIYan , HANJie , JIAYi-xin ,  MENGXu

Department of Cardiac Surgery, Beijing Heart Surgery Center for Transplantation and Heart Valve Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P. R. China;

Corresponding?author：

MENGXu, Email: mxu@263.net

Keywords：

Atrial fibrillation; Atrial appendage; Stroke

DOI：

10.7507/1007-4848.20150146

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To evaluate the performance and safety of a novel device for left atrial appengdage (LAA) closure in dogs. Methods Through the fourth left intercostal, the LAA clips were implanted at the base of LAA in six dogs. Macroscopic pathology, histopathology and biological detection were performed at 7 d, 60 d, 90 d, 180 d after implan-tation respectively. Results The devices were all successfully implanted at the base of LAA. There is no transposition of the LAA clips. Complete fibrosis and atrophy of LAA occurred at 60 d after implantation. LAA closure was completed with a new endothelial tissue layer developed on the occluded orifice of the left atrium after 60 d after implantation. The level of atrial natriuretic peptide did not decrease significantly after the device implantation (275.64±60.00 pg/ml vs. 248.34±56.10 pg/ml, P=0.529). Conclusion The novel device for LAA closure achieved easy, reliable and safe closure of the LAA in canine model.

Citation： ZHENGShuai, ZHANGHai-bo, LIYan, HANJie, JIAYi-xin, MENGXu. Preliminary Experimental Study of a Novel Device for Left Atrial Appendage Closure. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(6): 572-577. doi: 10.7507/1007-4848.20150146 Copy

1.	?黃從新, 張澍, 馬長生, 等. 心房顫動:目前的認識和治療建議——2012. 中華心律失常學雜志, 2012, 16(4): 246-289.
2.	Bungard TJ, Ghali WA, Teo KK, et al. Why do patients with atrial fibrillation not receive warfarin? Arch Intern Med, 2000, 160(1): 41-46.
3.	Blackshear JL, Odell JA. Appendage obliteration to reduce stroke in cardiac surgical patients with atrial fibrillation. Ann Thorac Surg, 1996, 61(2): 755-759.
4.	Kanderian AS, Gillinov AM, Pettersson GB, et al. Success of surgical left atrial appendage closure: Assessment by transesophageal echocardiography. J Am Coll Cardiol, 2008, 52(11): 924-929.
5.	Healey JS, Crystal E, Lamy A, et al. Left atrial appendage occlusion study (laaos): Results of a randomized controlled pilot study of left atrial appendage occlusion during coronary bypass surgery in patients at risk for stroke. Am Heart J, 2005, 150(2): 288-293.
6.	Reddy VY, Holmes D, Doshi SK, et al. Safety of percutaneous left atrial appendage closure: Results from the watchman left atrial appendage system for embolic protection in patients with af (protect af) clinical trial and the continued access registry. Circulation, 2011, 123(4): 417-424.
7.	Stollberger C, Schneider B, Finsterer J. Serious complications from dislocation of a watchman left atrial appendage occluder. J Cardiovasc Electrophysiol, 2007, 18(8): 880-881.
8.	Ailawadi G, Gerdisch MW, Harvey RL, et al. Exclusion of the left atrial appendage with a novel device: Early results of a multicenter trial. J Thorac Cardiovasc Surg, 2011, 142(5): 1002-1009, 1009 e1001.
9.	Bruce CJ, Stanton CM, Asirvatham SJ, et al. Percutaneous epicardial left atrial appendage closure: Intermediate-term results. J Cardiovasc Electrophysiol, 2011, 22(1): 64-70.
10.	McCarthy PM, Lee R, Foley JL, et al. Occlusion of canine atrial appendage using an expandable silicone band. J Thorac Cardiovasc Surg, 2010, 140(4): 885-889.
11.	Slater AD, Tatooles AJ, Coffey A, et al. Prospective clinical study of a novel left atrial appendage occlusion device. Ann Thorac Surg, 2012, 93(6): 2035-2040.
12.	Johnson WD, Ganjoo AK, Stone CD, et al. The left atrial appendage: Our most lethal human attachment! Surgical implications. Eur J Cardiothorac Surg, 2000, 17(6): 718-722.
13.	楊嵩,張希,唐白云,等. 永久性心房顫動外科雙極射頻消融術的效果. 中國胸心血管外科臨床雜志, 2012, 19(3): 254-257.
14.	Cox JL. Mechanical closure of the left atrial appendage: Is it time to be more aggressive? J Thorac Cardiovasc Surg, 2013, 146(5): 1018-1027 e1012.
15.	January CT, Wann LS, Alpert JS, et al. 2014 aha/acc/hrs guideline for the management of patients with atrial fibrillation: A report of the american college of cardiology/american heart association task force on practice guidelines and the heart rhythm society. J Am Coll Cardiol 2014.
16.	Katz ES, Tsiamtsiouris T, Applebaum RM, et al. Surgical left atrial appendage ligation is frequently incomplete: A transesophageal echocardiograhic study. J Am Coll Cardiol, 2000, 36(2): 468-471.
17.	Fumoto H, Gillinov AM, Ootaki Y, et al. A novel device for left atrial appendage exclusion: The third-generation atrial exclusion device. J Thorac Cardiovasc Surg, 2008, 136(4): 1019-1027.
18.	Al-Saady NM, Obel OA, Camm AJ. Left atrial appendage: Structure, function, and role in thromboembolism. Heart, 1999, 82(5): 547-554.

1. ?黃從新, 張澍, 馬長生, 等. 心房顫動:目前的認識和治療建議——2012. 中華心律失常學雜志, 2012, 16(4): 246-289.
2. Bungard TJ, Ghali WA, Teo KK, et al. Why do patients with atrial fibrillation not receive warfarin? Arch Intern Med, 2000, 160(1): 41-46.
3. Blackshear JL, Odell JA. Appendage obliteration to reduce stroke in cardiac surgical patients with atrial fibrillation. Ann Thorac Surg, 1996, 61(2): 755-759.
4. Kanderian AS, Gillinov AM, Pettersson GB, et al. Success of surgical left atrial appendage closure: Assessment by transesophageal echocardiography. J Am Coll Cardiol, 2008, 52(11): 924-929.
5. Healey JS, Crystal E, Lamy A, et al. Left atrial appendage occlusion study (laaos): Results of a randomized controlled pilot study of left atrial appendage occlusion during coronary bypass surgery in patients at risk for stroke. Am Heart J, 2005, 150(2): 288-293.
6. Reddy VY, Holmes D, Doshi SK, et al. Safety of percutaneous left atrial appendage closure: Results from the watchman left atrial appendage system for embolic protection in patients with af (protect af) clinical trial and the continued access registry. Circulation, 2011, 123(4): 417-424.
7. Stollberger C, Schneider B, Finsterer J. Serious complications from dislocation of a watchman left atrial appendage occluder. J Cardiovasc Electrophysiol, 2007, 18(8): 880-881.
8. Ailawadi G, Gerdisch MW, Harvey RL, et al. Exclusion of the left atrial appendage with a novel device: Early results of a multicenter trial. J Thorac Cardiovasc Surg, 2011, 142(5): 1002-1009, 1009 e1001.
9. Bruce CJ, Stanton CM, Asirvatham SJ, et al. Percutaneous epicardial left atrial appendage closure: Intermediate-term results. J Cardiovasc Electrophysiol, 2011, 22(1): 64-70.
10. McCarthy PM, Lee R, Foley JL, et al. Occlusion of canine atrial appendage using an expandable silicone band. J Thorac Cardiovasc Surg, 2010, 140(4): 885-889.
11. Slater AD, Tatooles AJ, Coffey A, et al. Prospective clinical study of a novel left atrial appendage occlusion device. Ann Thorac Surg, 2012, 93(6): 2035-2040.
12. Johnson WD, Ganjoo AK, Stone CD, et al. The left atrial appendage: Our most lethal human attachment! Surgical implications. Eur J Cardiothorac Surg, 2000, 17(6): 718-722.
13. 楊嵩,張希,唐白云,等. 永久性心房顫動外科雙極射頻消融術的效果. 中國胸心血管外科臨床雜志, 2012, 19(3): 254-257.
14. Cox JL. Mechanical closure of the left atrial appendage: Is it time to be more aggressive? J Thorac Cardiovasc Surg, 2013, 146(5): 1018-1027 e1012.
15. January CT, Wann LS, Alpert JS, et al. 2014 aha/acc/hrs guideline for the management of patients with atrial fibrillation: A report of the american college of cardiology/american heart association task force on practice guidelines and the heart rhythm society. J Am Coll Cardiol 2014.
16. Katz ES, Tsiamtsiouris T, Applebaum RM, et al. Surgical left atrial appendage ligation is frequently incomplete: A transesophageal echocardiograhic study. J Am Coll Cardiol, 2000, 36(2): 468-471.
17. Fumoto H, Gillinov AM, Ootaki Y, et al. A novel device for left atrial appendage exclusion: The third-generation atrial exclusion device. J Thorac Cardiovasc Surg, 2008, 136(4): 1019-1027.
18. Al-Saady NM, Obel OA, Camm AJ. Left atrial appendage: Structure, function, and role in thromboembolism. Heart, 1999, 82(5): 547-554.

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Preliminary Experimental Study of a Novel Device for Left Atrial Appendage Closure

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