Novel streamlined technique for left atrial appendage closure using a radiofrequency wire-based large access system.

Autor: Asfour IK; Department of Medicine, East Tennessee University, Johnson City, Tennessee, USA., Elchouemi M; College of Natural Sciences, University of Texas, Austin, Texas, USA., Gianni C; Texas Cardiac Arrythmia Institute, St. David's Medical Center, Austin, Texas, USA., Helmy R; College of Natural Sciences, University of Texas, Austin, Texas, USA., Tschopp DR; Texas Cardiac Arrythmia Institute, St. David's Medical Center, Austin, Texas, USA.; Austin Heart Hospital, Austin, Texas, USA., Horton RP; Texas Cardiac Arrythmia Institute, St. David's Medical Center, Austin, Texas, USA., Natale A; Texas Cardiac Arrythmia Institute, St. David's Medical Center, Austin, Texas, USA., Al-Ahmad A; Texas Cardiac Arrythmia Institute, St. David's Medical Center, Austin, Texas, USA.
Jazyk: angličtina
Zdroj: Journal of cardiovascular electrophysiology [J Cardiovasc Electrophysiol] 2023 Aug; Vol. 34 (8), pp. 1690-1697. Date of Electronic Publication: 2023 Jul 07.
DOI: 10.1111/jce.15995
Abstrakt: Introduction: Transseptal puncture (TSP) to allow for large delivery sheath left atrial (LA) access remains a challenging aspect of LA appendage closure (LAAC) in patients with prior history of TSP, thick or lipomatous septum, atrial septal aneurysms, or other complex cardiac anatomies. This study investigates the use of the VersaCross large access (VLA) system (Baylis Medical/Boston Scientific) to improve procedural efficiency of LAAC compared to the standard needle workflow.
Methods and Results: Fifty LAAC procedures using WATCHMAN FLX between November 2021 and September 2022 were retrospectively analyzed comparing the VLA workflow (n = 25) to the standard needle workflow (n = 25). Study primary endpoint was time to procedural efficiency, and secondary endpoints included TSP time, acute LAAC success, fluoroscopy use, device recaptures, and periprocedural complications. Acute LAAC was successfully completed in all cases with no intraprocedural complications. TSP time was faster, but not significant, using the VLA workflow compared to the standard RF needle workflow (2.6 ± 1.1 min vs. 3.0 ± 1.8 min, p = 0.38). Time to WATCHMAN sheath in LA from TSP was 27% faster (1.5 ± 0.8 min vs. 2.1 ± 0.9 min; p = 0.03), and time to WATCHMAN release from TSP was 19% faster (10.5. ± 2.5 min vs. 13.0 ± 3.7 min; p = 0.01) with the VLA workflow. Overall procedure time was 15% faster (30.4 ± 5.1 min vs. 36.0 ± 6.6 min; p = 0.003) using VLA. Fluoroscopy time was 25% lower (4.0 ± 2.2 min vs. 5.5 ± 2.3 min; p = 0.003) and fluoroscopy dose was 60% lower (97.0 ± 91.7 mGy vs. 241.8 ± 240.6 mGy; p = 0.01) and more consistent [F-test, p ˂ 0.0001] using the VLA workflow compared to the needle workflow.
Conclusion: The VLA system streamlines LAAC procedures, improving LAAC efficiency and reducing fluoroscopy use by allowing for de novo dilation of the septum for large-bore delivery sheaths, and reducing device exchanges and delivery sheath manipulation.
(© 2023 The Authors. Journal of Cardiovascular Electrophysiology published by Wiley Periodicals LLC.)
Databáze: MEDLINE
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