Short and long-term outcomes of percutaneous left atrial appendage suture ligation: Results from a US multicenter evaluation

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• 作者：Dhanunjaya Lakkireddy ; MD^* ; ^{dlakkireddy@kumc.edu" class="auth_mail" title="E-mail the corresponding author} ; Muhammad R. Afzal ; MD^* ; Randall J. Lee ; MD ; PhD^&dagger ; ; Hosakote Nagaraj ; MD^&Dagger ; ; David Tschopp ; MD^§ ; ; Brett Gidney ; MD^║ ; Christopher Ellis ; MD^¶ ; ; Eric Altman ; MD^# ; Brian Lee ; MD^** ; Saibal Kar ; MD^&dagger ; &dagger ; ; Nitish Bhadwar ; MD^&dagger ; ; Mauricio Sanchez ; MD^&Dagger ; &Dagger ; ; Varuna Gadiyaram ; MD^§ ; § ; ; Rudolph Evonich ; MD^§ ; § ; ; Abdi Rasekh ; MD^¶ ; ¶ ; ; Jie Cheng ; MD^## ; ^*** ; Frank Cuoco ; MD^&dagger ; &dagger ; &dagger ; ; Sheetal Chandhok ; MD^&Dagger ; &Dagger ; &Dagger ; ; Sampath Gunda ; MD^* ; Madhu Reddy ; MD^* ; Donita Atkins ; BS^* ; Sudharani Bommana ; MPhil^* ; Phillip Cuculich ; MD^§ ; § ; § ; ; Douglas Gibson ; MD^&Dagger ; ; Jayant Nath ; MD^* ; Ryan Ferrell ; MD^* ; Earnest Matthew ; MD^* ; er" data-pos="28" data-tb="David Wilb║║"affiliation provided but citation not provided.so i given for last author... --> ; er ; MD^║║║
• 关键词：Left atrial appendage ; Stroke ; Atrial fibrillation ; LARIAT
• 刊名：Heart Rhythm
• 出版年：2016
• 出版时间：May 2016
• 年：2016
• 卷：13
• 期：5
• 页码：1030-1036
• 全文大小：335 K

文摘

Published studies of epicardial ligation of left atrial appendage (LAA) have reported discordant results.

Objective

The purpose of this study was to delineate the safety and efficacy of LAA closure with the LARIAT device.

Methods

This is a multicenter registry of 712 consecutive patients undergoing LAA ligation with LARIAT at 18 US hospitals. The primary end point was successful suture deployment, no leak by intraprocedural transesophageal echocardiography (TEE), and no major complication (death, stroke, cardiac perforation, and bleeding requiring transfusion) at discharge. A leak of 2–5 mm on follow-up TEE was the secondary end point.

Results

LARIAT was successfully deployed in 682 patients (95.5%). A complete closure was achieved in 669 patients (98%), while 13 patients (1.8%) had a trace leak (<2 mm). There was 1 death related to the procedure. Ten patients (1.44%) had cardiac perforation necessitating open heart surgery, while another 14 (2.01%) did not need surgery. The risk of cardiac perforation decreased significantly after the introduction of a micropuncture (MP) needle for pericardial access. Delayed complications (pericarditis requiring >2 weeks of treatment with nonsteroidal anti-inflammatory drugs/colchicine and pericardial and pleural effusion after discharge) occurred in 34 (4.78%) patients, and the risk decreased significantly with the periprocedural use of colchicine. Follow-up TEE (n = 480) showed a leak of 2–5 mm in 6.5% and a thrombus in 2.5%. One patient had a leak of >5 mm.

Conclusion

LARIAT effectively closes the LAA and has acceptable procedural risks with the evolution of the use of the micropuncture needle for pericardial access and the use of colchicine for mitigating the postinflammatory response associated with LAA ligation and pericardial access.