Is there an alternative treatment for patients intolerant to antiplatelet therapy if percutaneous left atrial appendage closure is considered?
| Autor: | B. P. van Putte, Ferdi Akca, S. E. Verstraeten, C. van Laar, A. H. M. van Straten, Niels Verberkmoes |
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| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
Percutaneous business.industry Left atrial appendage Original Article - Design Study Article Left atrial appendage closure Atrial fibrillation 030204 cardiovascular system & hematology medicine.disease Alternative treatment 03 medical and health sciences 0302 clinical medicine 030228 respiratory system Left atrial Residual flow Internal medicine Cardiology Epicardial Medicine In patient Closure (psychology) Cardiology and Cardiovascular Medicine business Contraindication |
| Zdroj: | Netherlands Heart Journal |
| ISSN: | 1876-6250 1568-5888 |
| Popis: | Introduction Left atrial appendage (LAA) closure has become of major interest for patients with atrial fibrillation intolerant to oral anticoagulation therapy (OAC). Patients with a contraindication to both OAC and antiplatelet therapy are not eligible for percutaneous LAA closure. We aimed to find an alternative treatment for these specific patients. Methods From March 2014 until December 2015 five patients were referred for percutaneous LAA closure. Alternative treatment was necessary due to an absolute contraindication to OAC and antiplatelet therapy (n = 4) or after previous failed percutaneous device implantation (n = 1). A stand-alone full thoracoscopic closure of the LAA using the Atriclip PRO device (AtriCure Inc., Dayton, OH, USA) was performed under guidance of transoesophageal echocardiography (TEE). After three months all patients underwent a computed tomography scan. Mean follow-up was 7.2 months [range 4.5–9.8 months]. Results All procedures were achieved without the occurrence of complications. Complete LAA closure was obtained in all patients without any residual flow confirmed by TEE. Postoperative computed tomography confirmed persisting adequate clip positioning with complete LAA closure and absence of intracardial thrombi. During follow-up no thromboembolic events occurred. Conclusion For atrial fibrillation patients with an absolute contraindication to OAC and antiplatelet therapy a stand-alone, minimally invasive thoracoscopic closure of the LAA is a safe and feasible alternative treatment. This might be a solution to avoid serious bleeding complications while eliminating the thromboembolic risk originating from the LAA in patients who are not eligible for percutaneous LAA closure. |
| Databáze: | OpenAIRE |
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