Evaluation of a novel device for left atrial appendage exclusion: The second-generation atrial exclusion device Keiji Kamohara, MD, Kiyotaka Fukamachi,

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Presentation transcript:

Evaluation of a novel device for left atrial appendage exclusion: The second-generation atrial exclusion device Keiji Kamohara, MD, Kiyotaka Fukamachi, MD, PhD, Yoshio Ootaki, MD, PhD, Masatoshi Akiyama, MD, PhD, Faruk Cingoz, MD, Chiyo Ootaki, MD, D. Geoffrey Vince, PhD, Zoran B. Popović, MD, Michael W. Kopcak, BA, Raymond Dessoffy, AA, Jenny Liu, BA, A. Marc Gillinov, MD The Journal of Thoracic and Cardiovascular Surgery Volume 132, Issue 2, Pages 340-346 (August 2006) DOI: 10.1016/j.jtcvs.2006.04.021 Copyright © 2006 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 The second-generation atrial exclusion device (AED) and the specially designed delivery tool. A, The skeleton of the AED, in the closed position, is composed of two titanium rigid tubes and two nitinol springs with a 90° angle at each end of the tubes. B, The AED with a polyester fabric in the open position. The titanium tubes are covered with both a urethane elastomer and a knit-braided polyester sheath. C, The delivery tool has long arms that allow device application to a distant anatomic structure. The Journal of Thoracic and Cardiovascular Surgery 2006 132, 340-346DOI: (10.1016/j.jtcvs.2006.04.021) Copyright © 2006 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Representative intraoperative views at implantation. A, The AED can be precisely positioned and then implanted using the delivery tool. B, The AED was implanted at the base of the LAA. The cranial end of the device was located underneath the main PA. *, LAA, Left atrial appendage; AED, second-generation atrial exclusion device; PA, pulmonary artery; LAD, left anterior descending artery; OM, obtuse marginal artery; LV, left ventricle. The Journal of Thoracic and Cardiovascular Surgery 2006 132, 340-346DOI: (10.1016/j.jtcvs.2006.04.021) Copyright © 2006 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Representative angiographic findings of the LCX at explantation. A and B, No adverse effects of the implanted AED on the LCX (dotted arrows) were found in LAO 60° or RAO 30° planes. AED, Second-generation atrial exclusion device; LCX, left circumflex artery; LAO, left anterior oblique; RAO, right anterior oblique. The Journal of Thoracic and Cardiovascular Surgery 2006 132, 340-346DOI: (10.1016/j.jtcvs.2006.04.021) Copyright © 2006 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Gross anatomic views of the internal surface of the LAA orifice and the cross section of the occlusion site at 90 days. A, The arrows indicate a smooth, clear, and linear occlusion site. No cul-de-sac formation was found. B, The occlusion line was fully covered with one layer of tissue ingrowth (small arrows). The LAA walls underneath both fabrics were very thin and were firmly adherent to each other. The distal LAA was atrophied, and its lumen was occupied with white connective tissue. The large and small dotted arrows indicate the cross sections of the great cardiac vein and left circumflex artery, respectively. There was no intraluminal thrombus in both vessels. LAA, Left atrial appendage; LA, left atrium; LV, left ventricle. The Journal of Thoracic and Cardiovascular Surgery 2006 132, 340-346DOI: (10.1016/j.jtcvs.2006.04.021) Copyright © 2006 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Histologic findings of the cross section of the occlusion site at 90 days. A, The endocardial surface of the occlusion site was covered with endothelium-like cells without producing irregularity on the endocardial surface (magnification × 20). B, The fibrous connective tissue with fibroblast infiltration was found between both fabrics and around the fabrics (magnification × 200). C, A neoendothelial layer and underlying layers of connective tissue expanding on the endocardial surface of the occlusion site were found (magnification × 200). *, Left atrial musculature; LA, left atrium; LAA, left atrial appendage; LV, left ventricle; LCX, left circumflex artery. The Journal of Thoracic and Cardiovascular Surgery 2006 132, 340-346DOI: (10.1016/j.jtcvs.2006.04.021) Copyright © 2006 The American Association for Thoracic Surgery Terms and Conditions