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A Review of the LARIAT Suture Delivery Device for Left Atrial Appendage Closure.

Safavi-Naeini P, Razavi M, Saeed M, Rasekh A, Massumi A - J Tehran Heart Cent (2015)

Bottom Line: The prevalence of atrial fibrillation (AF) is 1-2 % in the general population, and the risk of embolic stroke in AF patients is 4-5 times higher than that in the general population.AF-related strokes are often severe, and the rate of permanent disability is much higher among individuals who have AF-related strokes than in those who have strokes unrelated to AF.The purpose of this paper is to review the efficacy and safety of performing the LAA closure with the LARIAT Suture Delivery Device to prevent AF-related stroke in patients with contraindications to oral anticoagulant therapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Texas Heart Institute, Houston, Texas, USA.

ABSTRACT
The prevalence of atrial fibrillation (AF) is 1-2 % in the general population, and the risk of embolic stroke in AF patients is 4-5 times higher than that in the general population. AF-related strokes are often severe, and the rate of permanent disability is much higher among individuals who have AF-related strokes than in those who have strokes unrelated to AF. In patients with AF, more than 90 % of thrombi originate from the left atrial appendage (LAA). The purpose of this paper is to review the efficacy and safety of performing the LAA closure with the LARIAT Suture Delivery Device to prevent AF-related stroke in patients with contraindications to oral anticoagulant therapy.

No MeSH data available.


Related in: MedlinePlus

Fluoroscopic images of the LARIAT procedure. A) Delineation of the contours of the left atrial appendage (LAA) by contrast injection through the transseptal sheath placed at the LAA ostium (arrow) in the right anterior oblique view. B) The LAA and epicardial magnet-tipped wires are adjoined. A LARIAT snare (L) is placed at the LAA ostium from within the pericardial space, guided by a contrast-filled balloon. B) placed within the LAA ostium in the right anterior oblique view. C) Left atrial angiogram, showing the exclusion of the LAA in the left anterior oblique view (arrow).
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Figure 1: Fluoroscopic images of the LARIAT procedure. A) Delineation of the contours of the left atrial appendage (LAA) by contrast injection through the transseptal sheath placed at the LAA ostium (arrow) in the right anterior oblique view. B) The LAA and epicardial magnet-tipped wires are adjoined. A LARIAT snare (L) is placed at the LAA ostium from within the pericardial space, guided by a contrast-filled balloon. B) placed within the LAA ostium in the right anterior oblique view. C) Left atrial angiogram, showing the exclusion of the LAA in the left anterior oblique view (arrow).

Mentions: The LARIAT Suture Delivery Device, which has 510(k) approval from the United States Food and Drug Administration for soft-tissue occlusion, was invented by Dr. William Cohn, a cardiovascular surgeon at the Texas Heart Institute (THI).The device is used to tie off the LAA, thereby removing the main source of thrombi that cause strokes in patients with AF (Figure 1). For those who are appropriate candidates (Table 1),13, 14 the LARIAT procedure is performed by using opposite-pole, magnet-tipped guide wires (FindrWIRZ) with the patient under general anesthesia. The device consists of four main components: 1) a 15-mm–diameter balloon catheter compatible with 9-Fr access (Endo CATH); 2) 0.025-inch and 0.035-inch opposite-pole, magnet-tipped guide wires (FindrWIRZ); 3) a 13-Fr epicardial guide cannula (SofTIP); and 4) a 12-Fr suture delivery device.        13  One guide wire is placed in the apex of the LAA through a transseptal sheath, and the other is inserted into the epicardial space with the epicardial guide cannula through a subxiphoid puncture and is advanced toward the LAA to bind the other magnet-tipped guide wire. After the two magnetic wires are bound, the LARIAT snare is advanced over the epicardial guide wire and placed on the proximal end of the LAA to tighten a loop stitch around the base of the LAA. After the complete closure of the LAA has been confirmed with Doppler echocardiography (flow < 1 mm on cross section), the suture is released (Figure 2). The suture seals off the LAA from the rest of the heart, and the LAA shrinks afterwards.        13  The only material that remains in the body is the suture that ligates the LAA, and nothing is exposed on the endocardial side. Therefore, the use of Warfarin or other anticoagulants is not necessary after the procedure, and the patients are usually prescribed Aspirin and Clopidogrel upon hospital discharge. In addition, oral Colchicine is given for 1-2 weeks to prevent postoperative pericarditis.


A Review of the LARIAT Suture Delivery Device for Left Atrial Appendage Closure.

Safavi-Naeini P, Razavi M, Saeed M, Rasekh A, Massumi A - J Tehran Heart Cent (2015)

Fluoroscopic images of the LARIAT procedure. A) Delineation of the contours of the left atrial appendage (LAA) by contrast injection through the transseptal sheath placed at the LAA ostium (arrow) in the right anterior oblique view. B) The LAA and epicardial magnet-tipped wires are adjoined. A LARIAT snare (L) is placed at the LAA ostium from within the pericardial space, guided by a contrast-filled balloon. B) placed within the LAA ostium in the right anterior oblique view. C) Left atrial angiogram, showing the exclusion of the LAA in the left anterior oblique view (arrow).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4477089&req=5

Figure 1: Fluoroscopic images of the LARIAT procedure. A) Delineation of the contours of the left atrial appendage (LAA) by contrast injection through the transseptal sheath placed at the LAA ostium (arrow) in the right anterior oblique view. B) The LAA and epicardial magnet-tipped wires are adjoined. A LARIAT snare (L) is placed at the LAA ostium from within the pericardial space, guided by a contrast-filled balloon. B) placed within the LAA ostium in the right anterior oblique view. C) Left atrial angiogram, showing the exclusion of the LAA in the left anterior oblique view (arrow).
Mentions: The LARIAT Suture Delivery Device, which has 510(k) approval from the United States Food and Drug Administration for soft-tissue occlusion, was invented by Dr. William Cohn, a cardiovascular surgeon at the Texas Heart Institute (THI).The device is used to tie off the LAA, thereby removing the main source of thrombi that cause strokes in patients with AF (Figure 1). For those who are appropriate candidates (Table 1),13, 14 the LARIAT procedure is performed by using opposite-pole, magnet-tipped guide wires (FindrWIRZ) with the patient under general anesthesia. The device consists of four main components: 1) a 15-mm–diameter balloon catheter compatible with 9-Fr access (Endo CATH); 2) 0.025-inch and 0.035-inch opposite-pole, magnet-tipped guide wires (FindrWIRZ); 3) a 13-Fr epicardial guide cannula (SofTIP); and 4) a 12-Fr suture delivery device.        13  One guide wire is placed in the apex of the LAA through a transseptal sheath, and the other is inserted into the epicardial space with the epicardial guide cannula through a subxiphoid puncture and is advanced toward the LAA to bind the other magnet-tipped guide wire. After the two magnetic wires are bound, the LARIAT snare is advanced over the epicardial guide wire and placed on the proximal end of the LAA to tighten a loop stitch around the base of the LAA. After the complete closure of the LAA has been confirmed with Doppler echocardiography (flow < 1 mm on cross section), the suture is released (Figure 2). The suture seals off the LAA from the rest of the heart, and the LAA shrinks afterwards.        13  The only material that remains in the body is the suture that ligates the LAA, and nothing is exposed on the endocardial side. Therefore, the use of Warfarin or other anticoagulants is not necessary after the procedure, and the patients are usually prescribed Aspirin and Clopidogrel upon hospital discharge. In addition, oral Colchicine is given for 1-2 weeks to prevent postoperative pericarditis.

Bottom Line: The prevalence of atrial fibrillation (AF) is 1-2 % in the general population, and the risk of embolic stroke in AF patients is 4-5 times higher than that in the general population.AF-related strokes are often severe, and the rate of permanent disability is much higher among individuals who have AF-related strokes than in those who have strokes unrelated to AF.The purpose of this paper is to review the efficacy and safety of performing the LAA closure with the LARIAT Suture Delivery Device to prevent AF-related stroke in patients with contraindications to oral anticoagulant therapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Texas Heart Institute, Houston, Texas, USA.

ABSTRACT
The prevalence of atrial fibrillation (AF) is 1-2 % in the general population, and the risk of embolic stroke in AF patients is 4-5 times higher than that in the general population. AF-related strokes are often severe, and the rate of permanent disability is much higher among individuals who have AF-related strokes than in those who have strokes unrelated to AF. In patients with AF, more than 90 % of thrombi originate from the left atrial appendage (LAA). The purpose of this paper is to review the efficacy and safety of performing the LAA closure with the LARIAT Suture Delivery Device to prevent AF-related stroke in patients with contraindications to oral anticoagulant therapy.

No MeSH data available.


Related in: MedlinePlus