A novel device for left atrial appendage exclusion: The third-generation atrial exclusion device

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 136; no. 4; pp. 1019 - 1027
• Main Authors: Fumoto, Hideyuki, MD, Gillinov, A. Marc, MD, Ootaki, Yoshio, MD, PhD, Akiyama, Masatoshi, MD, PhD, Saeed, Diyar, MD, Horai, Tetsuya, MD, Ootaki, Chiyo, MD, Vince, D. Geoffrey, PhD, Popović, Zoran B., MD, Dessoffy, Raymond, AA, Massiello, Alex, MEBME, Catanese, Jacquelyn, MA, Fukamachi, Kiyotaka, MD, PhD
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Mosby, Inc 01.10.2008; AATS/WTSA; Elsevier
• Subjects: Analysis of Variance; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Angiography; Animals; Atrial Appendage - pathology; Atrial Appendage - surgery; Atrial Fibrillation - prevention & control; Biological and medical sciences; Cardiology. Vascular system; Cardiothoracic Surgery; Disease Models, Animal; Dogs; Echocardiography, Doppler; Hemodynamics - physiology; Immunohistochemistry; Medical sciences; Natriuretic Peptide, Brain - metabolism; Pneumology; Probability; Prostheses and Implants; Prosthesis Design; Prosthesis Implantation - methods; Random Allocation; Sensitivity and Specificity; Stroke - prevention & control; Surgical Instruments; AED; EE; LCX; ANP; atrial exclusion device; AF; BNP; 28; 18; brain natriuretic peptide; epicardial echocardiography; LAA; left circumflex artery; 2-dimensional; atrial fibrillation; 2D; RAA; left atrial appendage; atrial natriuretic peptide; right atrial appendage; Anesthesia; Generation; Circulatory system; Left atrium; Cardiology; Device
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2008.06.002

Objective Occlusion of the left atrial appendage is proposed to reduce the risk of stroke in patients with atrial fibrillation. The third-generation atrial exclusion device, modified to provide uniform distribution of pressure at appendage exclusion, was assessed for safety and effectiveness in a canine model and compared with a surgical stapler. Methods The atrial exclusion device consists of 2 parallel, straight, rigid titanium tubes and 2 nitinol springs with a knit-braided polyester fabric. Fourteen mongrel dogs were implanted with the device at the base of the left atrial appendage via a median sternotomy. In each dog, the right atrial appendage was stapled with a commercial apparatus for comparison. The animals were evaluated at 7 days (n = 3), 30 days (n = 5), and 90 days (n = 6) after implantation by epicardial echocardiography, left atrial and coronary angiography, gross pathology, and histology. Results Left atrial appendage exclusion was complete and achieved without hemodynamic instability, and coronary angiography revealed that the left circumflex artery was patent in all cases. A new endothelial tissue layer developed on the occluded orifice of the left atrium 90 days after implantation. This endothelial layer was not evident on the stapled right atrial appendage. Conclusion In dogs, the third-generation atrial exclusion device achieved easy, reliable, and safe exclusion of the left atrial appendage with favorable histologic results. Clinical application could provide a new therapeutic option for reducing the risk of stroke in patients with atrial fibrillation.