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Procedural Complications and Management

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Left Atrial Appendage Closure

Part of the book series: Contemporary Cardiology ((CONCARD))

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Abstract

The vast majority (>90 %) of complications related to left atrial appendage (LAA) closure are procedure-related, occurring within 7 days of the index procedure [1]. These complications attenuate the overall clinical benefit of this strategy for stroke prophylaxis in patients with non-valvular atrial fibrillation and highlight the importance of the safe execution of the procedure to maximize the overall clinical benefits of LAA occlusion in this patient cohort [2]. The current chapter will outline the major procedural complications of LAA closure and discuss their management. Although a large number of LAA occlusion devices have now been developed [3], the majority of the discussion will center around second generation devices for which there is reasonable registry or randomized trial data available (i.e., WATCHMAN, Boston Scientific, and Amplatzer Cardiac Plug (ACP), St Jude Medical).

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References

  1. Reddy VY, Holmes D, Doshi SK, Neuzil P, Kar S. 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):417–24.

    Article  PubMed  Google Scholar 

  2. Holmes Jr DR, Lakkireddy DR, Whitlock RP, Waksman R, Mack MJ. Left atrial appendage occlusion: opportunities and challenges. J Am Coll Cardiol. 2014;63(4):291–8.

    Article  PubMed  Google Scholar 

  3. Bergmann MW, Landmesser U. Left atrial appendage closure for stroke prevention in non-valvular atrial fibrillation: rationale, devices in clinical development and insights into implantation techniques. EuroIntervention. 2014;10(4):497–504.

    Article  PubMed  Google Scholar 

  4. Holmes DR, Reddy VY, Turi ZG, Doshi SK, Sievert H, Buchbinder M, et al. Percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrillation: a randomised non-inferiority trial. Lancet. 2009;374(9689):534–42.

    Article  CAS  PubMed  Google Scholar 

  5. Holmes Jr DR, Kar S, Price MJ, Whisenant B, Sievert H, Doshi SK, et al. Prospective randomized evaluation of the Watchman Left Atrial Appendage Closure device in patients with atrial fibrillation versus long-term warfarin therapy: the PREVAIL trial. J Am Coll Cardiol. 2014;64(1):1–12.

    Article  PubMed  Google Scholar 

  6. Park JW, Bethencourt A, Sievert H, Santoro G, Meier B, Walsh K, et al. Left atrial appendage closure with Amplatzer cardiac plug in atrial fibrillation: initial European experience. Catheter Cardiovasc Interv. 2011;77(5):700–6.

    Article  PubMed  Google Scholar 

  7. Urena M, Rodes-Cabau J, Freixa X, Saw J, Webb JG, Freeman M, et al. Percutaneous left atrial appendage closure with the AMPLATZER cardiac plug device in patients with nonvalvular atrial fibrillation and contraindications to anticoagulation therapy. J Am Coll Cardiol. 2013;62(2):96–102.

    Article  PubMed  Google Scholar 

  8. Schroeter MR, Danner BC, Hunlich M, Schillinger W. Uncommon delayed and late complications after percutaneous left atrial appendage closure with Amplatzer((R)) Cardiac Plug. Clin Res Cardiol. 2014;103(4):285–90.

    Article  PubMed  Google Scholar 

  9. Bianchi G, Solinas M, Gasbarri T, Bevilacqua S, Tiwari KK, Berti S, et al. Pulmonary artery perforation by plug anchoring system after percutaneous closure of left appendage. Ann Thorac Surg. 2013;96(1):e3–5.

    Article  PubMed  Google Scholar 

  10. Hanazawa K, Brunelli M, Saenger J, Grosse A, Raffa S, Lauer B, et al. Close proximity between pulmonary artery and left atrial appendage leading to perforation of the artery, tamponade and death after appendage closure using cardiac plug device. Int J Cardiol. 2014;175(2):e35–6.

    Article  PubMed  Google Scholar 

  11. Meier B, Tarbine SG, Costantini CR. Percutaneous management of left atrial appendage perforation during device closure. Catheter Cardiovasc Interv. 2014;83(2):305–7.

    Article  PubMed  Google Scholar 

  12. Bajaj NS, Parashar A, Agarwal S, Sodhi N, Poddar KL, Garg A, et al. Percutaneous left atrial appendage occlusion for stroke prophylaxis in nonvalvular atrial fibrillation: a systematic review and analysis of observational studies. JACC Cardiovasc Interv. 2014;7(3):296–304.

    Article  PubMed  Google Scholar 

  13. Aminian A, Chouchane I, Compagnie M, Decubber M, Lalmand J. Delayed and fatal embolization of a left atrial appendage closure device. Circ Cardiovasc Interv. 2014;7(4):628–30.

    Article  PubMed  Google Scholar 

  14. Gupta P, Szczeklik M, Selvaraj A, Lall KS. Emergency surgical retrieval of a migrated left atrial appendage occlusion device. J Card Surg. 2013;28(1):26–8.

    Article  CAS  PubMed  Google Scholar 

  15. Pisani P, Sandrelli L, Fabbrocini M, Tesler UF, Medici D. Left-atrial-appendage occluder migrates in an asymptomatic patient. Tex Heart Inst J. 2014;41(4):443–4.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Plicht B, Konorza TF, Kahlert P, Al-Rashid F, Kaelsch H, Janosi RA, et al. Risk factors for thrombus formation on the Amplatzer Cardiac Plug after left atrial appendage occlusion. JACC Cardiovasc Interv. 2013;6(6):606–13.

    Article  PubMed  Google Scholar 

  17. Fernandez-Rodriguez D, Vannini L, Martin-Yuste V, Brugaletta S, Robles R, Regueiro A, et al. Medical management of connector pin thrombosis with the Amplatzer cardiac plug left atrial closure device. World J Cardiol. 2013;5(10):391–3.

    PubMed Central  PubMed  Google Scholar 

  18. Freixa X, Chan JL, Tzikas A, Garceau P, Basmadjian A, Ibrahim R. The Amplatzer Cardiac Plug 2 for left atrial appendage occlusion: novel features and first-in-man experience. EuroIntervention. 2013;8(9):1094–8.

    Article  PubMed  Google Scholar 

  19. Viles-Gonzalez JF, Kar S, Douglas P, Dukkipati S, Feldman T, Horton R, et al. The clinical impact of incomplete left atrial appendage closure with the Watchman Device in patients with atrial fibrillation: a PROTECT AF (Percutaneous Closure of the Left Atrial Appendage Versus Warfarin Therapy for Prevention of Stroke in Patients With Atrial Fibrillation) substudy. J Am Coll Cardiol. 2012;59(10):923–9.

    Article  PubMed  Google Scholar 

  20. Casserly IP. Vascular access and closure issues in structural heart disease interventions. In: Carroll JD, Webb JG, editors. Structural heart disease interventions. Philadelphia: Lippincott Williams & Wilkins; 2012.

    Google Scholar 

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Author information

Authors and Affiliations

  1. Mater Misericordiae Hospital and Mater Private Hospital, Eccles St., Dublin, Ireland

    Ivan P. Casserly M.B., B.Ch. & Kevin Walsh M.B., B.Ch.

  2. Vancouver General Hospital, University of British Columbia, 2775 Laurel Street, Level 9, Vancouver, BC, Canada, V5Z1M9

    Jacqueline Saw MD, FRCPC, FACC, FSCAI

Authors
  1. Ivan P. Casserly M.B., B.Ch.
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  2. Kevin Walsh M.B., B.Ch.
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  3. Jacqueline Saw MD, FRCPC, FACC, FSCAI
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Corresponding author

Correspondence to Ivan P. Casserly M.B., B.Ch. .

Editor information

Editors and Affiliations

  1. Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada

    Jacqueline Saw

  2. Cardiovascular Intervention Center Research, Cedars-Sinai Medical Center, Los Angeles, California, USA

    Saibal Kar

  3. Scripps Translational Science Institute, Division of Cardiovascular Diseases, Scripps Clinic, La Jolla, California, USA

    Matthew J. Price

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© 2016 Springer International Publishing Switzerland

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Casserly, I.P., Walsh, K., Saw, J. (2016). Procedural Complications and Management. In: Saw, J., Kar, S., Price, M. (eds) Left Atrial Appendage Closure. Contemporary Cardiology. Humana Press, Cham. https://doi.org/10.1007/978-3-319-16280-5_18

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  • DOI: https://doi.org/10.1007/978-3-319-16280-5_18

  • Publisher Name: Humana Press, Cham

  • Print ISBN: 978-3-319-16279-9

  • Online ISBN: 978-3-319-16280-5

  • eBook Packages: MedicineMedicine (R0)

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