Acute Feasibility of Vacuum-Assisted Catheter-Based Left Atrial Appendage Inversion in a Swine Model.

BACKGROUND

The left atrial appendage (LAA) is the predominant site of thrombus formation in atrial fibrillation. Current percutaneous LAA occlusion devices require permanent implants. A catheter-based, non-implant mechanical inversion strategy may offer an alternative approach to stroke prevention.

OBJECTIVES

To assess the feasibility of vacuum-assisted catheter-based inversion of the LAA using transseptal aspiration in a swine model.

METHODS

A 59-kg domestic swine underwent transseptal access via the right femoral vein under fluoroscopy, transesophageal echocardiography (TEE), and intracardiac echocardiography (ICE). A 22-F aspiration catheter was advanced into the left atrium and positioned at the LAA apex. Negative pressure was generated manually with a 60-mL syringe attached to the aspiration port, and sequential suction-traction maneuvers were performed to induce LAA inversion. Procedural feasibility, hemodynamic stability, imaging changes, and gross pathology were assessed.

RESULTS

LAA suction and inversion were feasible. Sequential negative pressure applications resulted in complete inversion, confirmed by multiplane TEE. A mild, non-hemodynamically significant pericardial effusion occurred. Necropsy showed focal apex injury consistent with catheter stiffness and suction forces.

CONCLUSIONS

Catheter-based vacuum-assisted LAA inversion was technically feasible in this acute swine experiment. However, chronic survival studies are required to evaluate durability of inversion, tissue healing, thrombogenicity, and long-term safety before clinical translation can be considered.