Left atrial appendage exclusion: An alternative to anticoagulation in nonvalvular atrial fibrillation Kareem Bedeir, MBChB, MS, David R. Holmes, MD,

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Presentation transcript:

Left atrial appendage exclusion: An alternative to anticoagulation in nonvalvular atrial fibrillation Kareem Bedeir, MBChB, MS, David R. Holmes, MD, James L. Cox, MD, Basel Ramlawi, MD, MSc The Journal of Thoracic and Cardiovascular Surgery Volume 153, Issue 5, Pages 1097-1105 (May 2017) DOI: 10.1016/j.jtcvs.2016.12.040 Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Endocardial left atrial appendage occluding devices. A, The PLAATO device. B, The Watchman. C, The Amplatzer cardiac plug. The Journal of Thoracic and Cardiovascular Surgery 2017 153, 1097-1105DOI: (10.1016/j.jtcvs.2016.12.040) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Epicardial left atrial appendage occluding devices. A, The Lariat suture delivery system. B, The Cardioblate occlusion device. *Currently not approved by the Food and Drug Administration. C, The TigerPaw system II. D, The Atriclip exclusion system (standard open approach). E, The Atriclip exclusion system (thoracoscopic approach). The Journal of Thoracic and Cardiovascular Surgery 2017 153, 1097-1105DOI: (10.1016/j.jtcvs.2016.12.040) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Proposed approach to stroke risk reduction in patients with atrial fibrillation not undergoing open cardiac procedures. *Preferred, with contraindications to anticoagulation or unfavorable left atrial appendage morphology. **Preferred with nonsurgical candidates and those with previous cardiac or left thoracic surgery. CHA2DS2-VASc, congestive heart failure, hypertension, age >75 and diabetes mellitus, previous history of stroke or transient ischemic attack, vascular disease, age 65-74 years, and female sex category; AC, anticoagulation, TTR, time in therapeutic range, LAA, left atrial appendage; LAAE, left atrial appendage exclusion. The Journal of Thoracic and Cardiovascular Surgery 2017 153, 1097-1105DOI: (10.1016/j.jtcvs.2016.12.040) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 The Watchman endocardial left atrial occlusion device (left) and the AtriClip epicardial left atrial occlusion device (right). The Journal of Thoracic and Cardiovascular Surgery 2017 153, 1097-1105DOI: (10.1016/j.jtcvs.2016.12.040) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

The Watchman endocardial left atrial occlusion device (left) and the AtriClip epicardial left atrial occlusion device (right). The Journal of Thoracic and Cardiovascular Surgery 2017 153, 1097-1105DOI: (10.1016/j.jtcvs.2016.12.040) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions