New approach to left atrial appendage occlusion

When Watchman or Amulet can’t solve the problem, this just might

A group of Norton Healthcare physicians is using a novel approach to mitral valve repair. Research has shown that many patients with suture-based left atrial appendage surgical ligation have incomplete closure that puts them at risk for thromboembolic events. Closure of the LAA, either via percutaneous or surgical methods, could decrease risk. Thrombi typically arise in the left atrial appendage (LAA), so anticoagulation approaches alone are insufficient.

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Sometimes commercially available devices are not applicable to these situations, so other accommodations must be made. Daniel P. Rothschild, M.D., interventional/structural cardiologist, tweeted a step-by-step series demonstrating a new method on a patient (with the patient’s permission). Daniel S. Stewart, M.D., interventional/structural cardiologist, and Steven M. Peterson, M.D., cardiothoracic surgeon, co-authored a piece on the topic with Dr. Rothschild.

The procedure was performed on a 76-year-old female whose prior mitral valve repair had an incomplete ligation of the left atrial appendage. After a spontaneous retroperitoneal hematoma, she was referred for closure. The approach to closure is described in further detail and with visuals in the article and in the Twitter thread. The patient was discharged the following day.

Patient story is shared with permission.

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