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Strategy to optimize PeriproCeduraL AnticOagulation in structural transseptal interventions: Design and rationale of the STOP CLOT trial.

BACKGROUND: Both transcatheter edge-to-edge repair (TEER) of mitral regurgitation or left atrial appendage closure (LAAC) require periprocedural anticoagulation with unfractionated heparin (UFH) that is administered either before or immediately after transseptal puncture (TSP). The optimal timing of UFH administration (before or after TSP) is unknown. The Strategy To Optimize PeriproCeduraL AnticOagulation in Structural Transseptal Interventions trial (STOP CLOT Trial) was designed to determine if early anticoagulation is effective in reducing ischemic complications without increasing the risk…

Outcomes for single antiplatelet, dual antiplatelet, or oral anticoagulation after Amulet: Insights from EMERGE LAA post-approval study.

BACKGROUND: Outcomes associated with different antithrombotic strategies after Amulet left atrial appendage occlusion (LAAO) are not well described. OBJECTIVE: This analysis compared outcomes from patients discharged on dual antiplatelet therapy (DAPT) versus single antiplatelet therapy (SAPT) or oral anticoagulation (OAC) following Amulet implant in the EMERGE LAA post-approval study. METHODS: Patients with a successful Amulet implant and discharged from the hospital between August 14, 2021 and December 15, 2023 and entered into the National Cardiovascular Data Registry (NCDR) LAAO Registry

Use of the ClearSight® System for Continuous Noninvasive Hemodynamic Monitoring during Heart Valve Interventions: Review of the Literature and Single-Site Experience.

During interventional and structural cardiology procedures, such as mitral valve (MitraClip, BMV), aortic valve (TAVR, BAV), tricuspid valve (MitraClip), left atrial appendage (Watchman, Lariat), atrial septum (ASD/PFO closure), and coronary artery intervention (high-risk PCI), among others, patients are at a high risk of hemodynamic instability and require continuous monitoring. This is conventionally achieved through arterial catheterization and transpulmonary thermodilution. However, such invasive techniques are time-consuming and have been associated with steep learning curves, vascular co

Clinical Effectiveness of Transcatheter Left Atrial Appendage Occlusion With Watchman FLX Compared With First-Generation Watchman.

BACKGROUND: Procedural complications, device-related thrombus, and peridevice leak may limit the benefit of transcatheter left atrial appendage occlusion (LAAO). Although next-generation devices incorporate design modifications meant to address these phenomena, the longer term impact of these modifications on outcomes has not been described. OBJECTIVES: The aim of this study was to compare 1-year safety and clinical effectiveness of the Watchman FLX with the predicate Watchman 2.5 device. METHODS: The National Cardiovascular Data Registry LAAO Registry was used to identify: 1) patients who r

Clinical Outcomes of the First 200 Cases of Single-Operator TEE-Guided Left Atrial Appendage Occlusion (SOLOCLOSE).

SOLOCLOSE is a simplified methodology for left atrial appendage occlusion (LAAO) with the Watchman device consisting of single-operator TEE guidance, nurse-driven conscious sedation, same-day discharge, and deferment of any preprocedural imaging. We aim to investigate the efficacy and safety of LAAO with the SOLOCLOSE methodology. A single-center prospective analysis of 208 consecutive patients undergoing SOLOCLOSE between December 2020 and January 2024 was performed. The primary efficacy outcome was the rate of significant peri‑device (>5 mm) leak at 45-day TEE. The primary safety outcome was

Robotic mitral valve repair in octogenarians: safety and clinical outcomes compared with younger patients.

BACKGROUND: Robotic mitral valve (MV) repair has evolved as a minimally invasive surgical approach for mitral regurgitation (MR). However, e … id valve repair [7 (44%) vs. 10 (10%); P=0.002], Maze procedure [7 (44%) vs. 10 (10%); P=0.002] and left atrial appendage closure [8 (50%) vs. 9 (9%); P<0.001], were performed more frequently in octogenarians. Echocardiography at 1 week after surgery and at the 1-year follow-up showed that MR and TR were reduced to no more than mild in all older patients. Comparison of preoper …

Cardiac computed tomography angiography for assessment of endothelial insufficiency of left atrial appendage disc-like occluder.

INTRODUCTION: This study was performed to explore the diagnostic value of cardiac computed tomography angiography (CCTA) for endothelial insufficiency (EIS) of a left atrial appendage (LAA) disc-like occluder. METHODS: Fifty-nine patients with nonvalvular atrial fibrillation who underwent placement of an LAA disc-like occluder (LAmbre; Lifetech Scientific) in our hospital were retrospectively analyzed. Patients who were found to have contrast agent entering the LAA at the 3-month postoperative CCTA examination underwent Hounsfield unit (HU) measurement of the LAA and construction of a three-d

Direct Oral Anticoagulants in Older and Frail Patients with Atrial Fibrillation: A Decade of Experience.

INTRODUCTION: Both the prevalence of atrial fibrillation (AF) and its subsequent use of direct oral anticoagulants (DOACs) are rapidly increasing in patients of older age. In the absence of contra-indications, guidelines advocate anticoagulation based on the CHA2DS2-VASc score for all AF patients aged 75 and above. However, some practitioners are hesitant to prescribe anticoagulants to older and frail patients due to perceived elevated bleeding risks. This review delves into the comparative treatment outcomes of DOACs versus vitamin K antagonists (VKAs) in older patients with AF, particularly

Inter-atrial septal balloon dilation to facilitate intracardiac echocardiography guided left atrial appendage occlusion.

INTRODUCTION: Percutaneous left atrial appendage occlusion (LAAO) is traditionally performed under general anesthesia with trans-esophageal echocardiography guidance. Intracardiac echo (ICE)-guided LAAO closure is increasing in clinical use. The ICE catheter is crossed into LA via interatrial septum (IAS) after the septum is dilated with LAAO delivery sheath. This step can be time-consuming and requires significant ICE catheter manipulation, which increases the risk of cardiac perforation. Pre-emptive septal balloon dilation can potentially help with ICE advancement in the LA. We sought to eva

Transesophageal echocardiography complications associated with interventional cardiology procedures.

BACKGROUND: Although there have been several reports documenting complications related with transesophageal echocardiography (TEE) manipulation following cardiac surgery, there is a paucity of data regarding the safety of TEE used to guide catheter-based interventions. The aim of this study was to determine the prevalence, types and risk factors of complications associated with procedures requiring active TEE guidance. METHODS: This study included 1249 consecutive patients undergoing either transcatheter aortic valve implantation (TAVI), Mitraclip, left atrial appendage occlusion (LAAO) or pa

Watchman device migration and embolization: A report from the NCDR LAAO Registry.

INTRODUCTION: Incomplete anchoring of the Watchman left atrial appendage closure (LAAO) device can result in substantial device migration or device embolization (DME) requiring percutaneous or surgical retrieval. METHODS: We performed a retrospective analysis of Watchman procedures (January 2016 through March 2021) reported to the National Cardiovascular Data Registry LAAO Registry. We excluded patients with prior LAAO interventions, no device released, and missing device information. In-hospital events were assessed among all patients and postdischarge events were assessed among patients wit…

Radioprotection for Interventional Echocardiographers: A Consensus Statement of the Italian Society of Echocardiography and Cardiovascular Imaging.

The interventional echocardiographer (IE) plays a crucial role in structural heart interventions, yet faces significant risks from ionizing … ures guided by transesophageal echocardiography (TEE), such as transcatheter edge-to-edge repair or left atrial appendage closure. These findings, together with the recent reduction in recommended dose thresholds for deterministic effects like cataract formation, emphasize the urgent need to implement effective protective measures. Radiation exposure can be significantly reduc …

Recurrent mitral regurgitation after repair of Barlow's disease in a single-center retrospective cohort study.

BACKGROUND: Barlow's disease (BD) is a common etiology of degenerative mitral valve (MV) disease, often causing significant mitral regurgitation (MR). The pathology of BD is challenging for surgeons performing MV repair (MVR). However, most MVR effectiveness studies have been based on survival and risk of reoperation. The aim of this study was to analyze the safety, efficacy, and durability of MVR in patients with BD and to identify factors that influence recurrent MR. METHODS: We retrospectively analyzed the clinical outcomes of 274 patients undergoing MVR for BD at a tertiary hospital (Guan

Comparative Outcomes of Intracardiac vs Transesophageal Echocardiographic Guidance for Left Atrial Appendage Occlusion: Insights From EMERGE LAA Postapproval Study.

BACKGROUND: Transesophageal echocardiography (TEE) is commonly used to guide left atrial appendage occlusion (LAAO) procedures. Intracardiac echocardiography (ICE) is emerging as an alternative imaging modality with potential advantages over TEE. OBJECTIVES: The aim of this study was to compare outcomes from procedures guided by ICE vs TEE vs both for guidance of Amulet implantation in the EMERGE LAA postapproval study. METHODS: Patients with Amulet implants entered into the National Cardiovascular Data Registry LAAO Registry between August 14, 2021, and December 15, 2023. A safety composite

Four-year clinical and echocardiographic outcomes after tricuspid valve replacement using a novel bovine pericardial valve bioprosthesis.

OBJECTIVE: To describe our experience and evaluate the clinical outcomes and hemodynamic performance of a new bovine pericardial valve biopr … ss in 59.0% (49/83). Concomitant procedures included left-sided valvular surgery (47.0%, 39/83) and left atrial appendage closure (26.5%, 22/83). The most common prosthesis size was 33 mm (67.5%, 56/83). As the primary end point, no valve thrombosis was observed and 2.6% (2/77) developed severe central tricuspid regurgitation (TR) requiring percutaneous reintervention. New mod …

Percutaneous left atrial appendage occlusion: Effect of device positioning on outcome.

OBJECTIVE: The study in patients with percutaneous left atrial appendage (LAA) occlusion investigates clinical outcomes according to the position of the Amplatzer Cardiac Plug (ACP) disc. BACKGROUND: The ACP consists of a disc and an anchoring lobe. The disc is meant to cover the ostium of the LAA, but frequently retracts partially or completely into the neck of the LAA. It is not known whether a retracted disc affects outcome. METHODS: Outcomes of 169 consecutive patients (age 73.1 ± 10.4 years; 76% male) with successful LAA closure were analyzed according to the position of the ACP disc: g

Safety and Procedural Success of Left Atrial Appendage Exclusion With the Lariat Device: A Systematic Review of Published Reports and Analytic Review of the FDA MAUDE Database.

IMPORTANCE: The Lariat device has received US Food and Drug Administration (FDA) 510(k) clearance for soft-tissue approximation and is being widely used off-label for left atrial appendage (LAA) exclusion. A comprehensive analysis of safety and effectiveness has not been reported. OBJECTIVES: To perform a systematic review of published literature to assess safety and procedural success, defined as successful closure of the LAA during the index procedure, of the Lariat device. We performed a formal analytic review of the FDA MAUDE (Manufacturer and User Facility Device Experience) database to

Trends of Cardiovascular Interventions Stratified by Body Mass Index: An Analysis of the 2016-2020 Nationwide Inpatient Sample Population.

Background There is a scarcity of studies delineating the trends of cardiovascular interventions in the hospitalized population stratified by body mass index (BMI). Our study aimed to study the burden of cardiovascular interventions and outcomes by BMI. Methods We retrospectively analyzed the Nationwide Inpatient Sample (NIS) database between January 2016 and December 2020. We identified the population of interest using the International Classification of Diseases, Tenth Revision (ICD-10) code. We studied the BMI in five categories: "healthy weight" (HW; BMI < 19.9-24.9 kg/m2), "overweight" (O

A Comparative Study Between Different Surgical Techniques For Left Atrial Exclusion in Patients Undergoing Concomitant Cardiac Surgery.

OBJECTIVES: To find out the most successful surgical technique to obliterate left atrial appendage (LAA) in atrial fibrillation (AF) patients who had undergone concomitant cardiac surgery. BACKGROUND: About 10%-65% of patients develop AF following cardiac surgery [Rho 2009; Mathew 2004; Maesen 2012]. Cerebral cardio-embolic stroke remains the most serious complication in AF patients. LAA is the main anatomical source for thromboembolic events. The use of oral anticoagulants (OAG) is considered to be an effective method for reduction of thromboembolic complications [Johnson 2000]. The use of o

Left Atrial Appendage Occlusion in Cancer-Associated Atrial Fibrillation: Who, When, and How to Manage Antithrombotic Therapy.

BackgroundCancer-associated atrial fibrillation (AF) is increasingly common, posing dual risks of thrombosis and bleeding. Long-term oral anticoagulation is often limited in these patients due to drug interactions, thrombocytopenia, and treatment-related bleeding. Left atrial appendage occlusion (LAAO) offers a non-pharmacological alternative for stroke prevention, yet its optimal use in cancer remains uncertain.MethodsWe conducted a narrative review of studies from 2009 to October 2025 across PubMed, Embase, and Google Scholar, including randomized trials, observational studies, registries, c

Совпадение в полном тексте источника
… Leaks after left atrial appendage closure: Ignored or neglected? Cardiology . 2021 ; 146 ( 3 ): 384 – 391 . 33735867 10.1159/000513901 22 Saw J Holmes DR Cavalcante JL , et al. SCAI/HRS expert consensus statement on transcatheter left atrial appendage closure . … Left atrial appendage closure in atrial fibrillation patients with cancer . …