A novel device for left atrial appendage exclusion: The third-generation atrial exclusion device Hideyuki Fumoto, MD, A. Marc Gillinov, MD, Yoshio Ootaki,

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Presentation transcript:

A novel device for left atrial appendage exclusion: The third-generation atrial exclusion device Hideyuki Fumoto, MD, A. Marc Gillinov, MD, Yoshio Ootaki, MD, PhD, Masatoshi Akiyama, MD, PhD, Diyar Saeed, MD, Tetsuya Horai, MD, Chiyo Ootaki, MD, D. Geoffrey Vince, PhD, Zoran B. Popović, MD, Raymond Dessoffy, AA, Alex Massiello, MEBME, Jacquelyn Catanese, MA, Kiyotaka Fukamachi, MD, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 136, Issue 4, Pages 1019-1027 (October 2008) DOI: 10.1016/j.jtcvs.2008.06.002 Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Skeleton of the AED. A, Two parallel, straight, rigid titanium tubes with elastic nitinol springs and a 90-degree angle at both ends of the tubes. B, The 2 straight tubes are covered with urethane elastomer. C, The whole skeleton is covered with a knit-braided polyester sheath. AED, Atrial exclusion device (third generation). The Journal of Thoracic and Cardiovascular Surgery 2008 136, 1019-1027DOI: (10.1016/j.jtcvs.2008.06.002) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Coronary angiogram of the LCX at the terminal study. No adverse effects of the implanted AED (white arrows) on the LCX were found in left anterior oblique 60-degree planes (A) or right anterior oblique 30-degree planes (B). LCX, Left circumflex artery; AED, atrial exclusion device (third generation). The Journal of Thoracic and Cardiovascular Surgery 2008 136, 1019-1027DOI: (10.1016/j.jtcvs.2008.06.002) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Representative macroscopic images of the LAA in 90-day study. A, External surface of the left atrium. AED (black bar). The whole AED is covered with fibrous tissue. The LAA is completely atrophied (black arrows). B, Internal surface of the left atrium. The orifice of the LAA (black arrows) is completely occluded. The occlusion line is clear and smooth. Most of the occlusion line is filled with a white fibrous tissue. C, Cross-section of the LAA occluded by the AED. The thrombus in the LAA had already been organized. The polyester fabric is covered with thin, clear, whitish tissue, and the LAA wall is smooth. Thick fibrous tissue is seen beneath the AED (white arrow). LCX (black arrow). LA, Left atrium; AED, atrial exclusion device (third generation); LAA, left atrial appendage. The Journal of Thoracic and Cardiovascular Surgery 2008 136, 1019-1027DOI: (10.1016/j.jtcvs.2008.06.002) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Representative microscopic images of the LAA in 90-day study. A, Thick fibrous tissue is shown underneath the AED (magnification ×16). B, The fibrous tissue is smoothly covered with a new endothelial layer (black arrows) (magnification ×100). AED, Atrial exclusion device (third generation); LA, left atrium. The Journal of Thoracic and Cardiovascular Surgery 2008 136, 1019-1027DOI: (10.1016/j.jtcvs.2008.06.002) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Representative macroscopic images of the RAA in 90-day study. A, External surface of the stapled right atrium. The RAA had not collapsed yet. Black arrows indicate the stapled line. B, Internal surface of the right atrium. The stapled orifice of the RAA (black arrows) has indentation, although the orifice is completely occluded. C, Cross-section of the occlusion site by the stapler. The RAA was not completely atrophied, but it had not been replaced with fibrous tissue yet. The thrombus in the RAA had not been organized yet. RAA, right atrial appendage. The Journal of Thoracic and Cardiovascular Surgery 2008 136, 1019-1027DOI: (10.1016/j.jtcvs.2008.06.002) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 6 Representative microscopic images of the RAA in the 90-day study. A, The stapled site (black arrow). Fibrous tissue was found at the stapled site with calcium deposition, which implies a pathologic reaction to what had been a locus of severe inflammation (a purple spot on the stapled site) (magnification ×16). B, The internal surface of the stapled site (black arrows). A new smooth endothelial layer that can be seen at the LAA occluded by the AED has not been created (magnification ×100). LAA, Left atrial appendage; AED, atrial exclusion device (third generation). The Journal of Thoracic and Cardiovascular Surgery 2008 136, 1019-1027DOI: (10.1016/j.jtcvs.2008.06.002) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions