Minimally invasive surgical implantation of the percutaneous left atrial appendage transcatheter occlusion device: initial experience in a canine model

Innovations : Technology and Techniques in Cardiothoracic and Vascular Surgery
Arthur C Hill, T Sloane Guy

Abstract

Atrial fibrillation (AF) is a significant cause of thromboembolism and stroke. Left atrial appendage (LAA) occlusion is associated with a decreased risk of stroke in patients with AF. Percutaneous implantation of the percutaneous LAA transcatheter occlusion (PLAATO) device has shown reduction in stroke risk and decreased need for anticoagulation. A surgical method of PLAATO implantation is proposed for its utility and efficacy in cardiac surgical procedures, where LAA occlusion is indicated as a primary procedure or as an adjunct. We describe a surgical method for PLAATO deployment in an experimental model that simulates various operative scenarios including right minithoracotomy, right video-assisted thoracoscopic, or median sternotomy. The PLAATO LAA occlusion device was deployed into the LAA in six dogs using a right minithoracotomy incision and catheter deployment via direct left atrial access. Intracardiac echocardiography and left atrial angiography were used to size, position, and verify proper deployment of the device. Successful PLAATO deployment was achieved in six of the six dogs. One dog required replacement of an undersized device. One dog required replacement of an oversized device. Four dogs required minor reposi...Continue Reading

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