Safety and efficacy of left atrial appendage closure using an epicardial suture snaring device: Systematic review and current status
Introduction The LARIAT epicardial suture snaring device has been fraught with technical challenges and procedural complications. Over time, technique modification and improved operator experience have helped overcome many of these challenges. Methods and Results Studies reporting left atrial append...
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| Veröffentlicht in: | Journal of cardiovascular electrophysiology 2021-08, Vol.32 (8), p.2189-2198 |
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| creator | Sabzwari, Syed Rafay Ali Mehta, Nikhil A. Garg, Lohit Racharla, Lekha Kurtz, Emilee Afzal, Muhammad R. Turagam, Mohit K. Lakkireddy, Dhanunjaya |
| description | Introduction
The LARIAT epicardial suture snaring device has been fraught with technical challenges and procedural complications. Over time, technique modification and improved operator experience have helped overcome many of these challenges.
Methods and Results
Studies reporting left atrial appendage epicardial closure over a 12‐year period from 2009 to 2020 were evaluated. The primary efficacy outcome evaluated was left atrial appendage closure with residual flow ≤1 mm. Safety outcomes evaluated were periprocedural and long term complications after device placement. Nine studies consisting of 1430 patients were included in this analysis, of which 1386 (97%) underwent successful device placement. The mean age was 69.3 years, with a mean CHADS2‐VASC score of 3.78. Primary efficacy end point was achieved in 95.8% patients immediately after device placement, and in 92.8% patients on long term follow‐up. Early procedural complications consisted of pericardial effusion 5.6%, cardiac perforation 2.7%, pericarditis 2.6%, and need for open heart surgery 1.5%. Long term complications consisted of all‐cause mortality 2.3%, stroke 1.5%, and left atrial appendage thrombus 2.3%. Reduced complications were noted using micropuncture needles (2.20% vs. 10.14%; p |
| doi_str_mv | 10.1111/jce.15132 |
| format | Article |
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The LARIAT epicardial suture snaring device has been fraught with technical challenges and procedural complications. Over time, technique modification and improved operator experience have helped overcome many of these challenges.
Methods and Results
Studies reporting left atrial appendage epicardial closure over a 12‐year period from 2009 to 2020 were evaluated. The primary efficacy outcome evaluated was left atrial appendage closure with residual flow ≤1 mm. Safety outcomes evaluated were periprocedural and long term complications after device placement. Nine studies consisting of 1430 patients were included in this analysis, of which 1386 (97%) underwent successful device placement. The mean age was 69.3 years, with a mean CHADS2‐VASC score of 3.78. Primary efficacy end point was achieved in 95.8% patients immediately after device placement, and in 92.8% patients on long term follow‐up. Early procedural complications consisted of pericardial effusion 5.6%, cardiac perforation 2.7%, pericarditis 2.6%, and need for open heart surgery 1.5%. Long term complications consisted of all‐cause mortality 2.3%, stroke 1.5%, and left atrial appendage thrombus 2.3%. Reduced complications were noted using micropuncture needles (2.20% vs. 10.14%; p < .0001), a longer duration pericardial drainage, and use of anti‐inflammatory medications (1.58% vs. 8.4%). Oral anticoagulation use decreased from 44.7% to 22.9% post device implantation, and to 8.5% on last clinical follow up.
Conclusions
The LARIAT device is effective in epicardial closure of the left atrial appendage. Improvement in device techniques such as use of micropuncture needle, prophylactic colchicine, and maintenance of a pericardial drain have helped improve safety over time.</description><identifier>ISSN: 1045-3873</identifier><identifier>EISSN: 1540-8167</identifier><identifier>DOI: 10.1111/jce.15132</identifier><language>eng</language><publisher>Hoboken: Wiley Subscription Services, Inc</publisher><subject>atrial appendage ; Colchicine ; Effusion ; epicardial appendage closure ; Heart surgery ; Inflammation ; lariat ; Long term ; Patients ; Pericarditis ; pooled analysis ; Safety ; Sutures ; systematic review ; Thrombosis</subject><ispartof>Journal of cardiovascular electrophysiology, 2021-08, Vol.32 (8), p.2189-2198</ispartof><rights>2021 Wiley Periodicals LLC</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3302-7fc0aa63b33464e70bbbba8ab022440835f779db9abc3f13b746def02a27dd923</citedby><cites>FETCH-LOGICAL-c3302-7fc0aa63b33464e70bbbba8ab022440835f779db9abc3f13b746def02a27dd923</cites><orcidid>0000-0002-9387-4369 ; 0000-0002-3343-7618 ; 0000-0001-5971-2158</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fjce.15132$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fjce.15132$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,778,782,1414,27907,27908,45557,45558</link.rule.ids></links><search><creatorcontrib>Sabzwari, Syed Rafay Ali</creatorcontrib><creatorcontrib>Mehta, Nikhil A.</creatorcontrib><creatorcontrib>Garg, Lohit</creatorcontrib><creatorcontrib>Racharla, Lekha</creatorcontrib><creatorcontrib>Kurtz, Emilee</creatorcontrib><creatorcontrib>Afzal, Muhammad R.</creatorcontrib><creatorcontrib>Turagam, Mohit K.</creatorcontrib><creatorcontrib>Lakkireddy, Dhanunjaya</creatorcontrib><title>Safety and efficacy of left atrial appendage closure using an epicardial suture snaring device: Systematic review and current status</title><title>Journal of cardiovascular electrophysiology</title><description>Introduction
The LARIAT epicardial suture snaring device has been fraught with technical challenges and procedural complications. Over time, technique modification and improved operator experience have helped overcome many of these challenges.
Methods and Results
Studies reporting left atrial appendage epicardial closure over a 12‐year period from 2009 to 2020 were evaluated. The primary efficacy outcome evaluated was left atrial appendage closure with residual flow ≤1 mm. Safety outcomes evaluated were periprocedural and long term complications after device placement. Nine studies consisting of 1430 patients were included in this analysis, of which 1386 (97%) underwent successful device placement. The mean age was 69.3 years, with a mean CHADS2‐VASC score of 3.78. Primary efficacy end point was achieved in 95.8% patients immediately after device placement, and in 92.8% patients on long term follow‐up. Early procedural complications consisted of pericardial effusion 5.6%, cardiac perforation 2.7%, pericarditis 2.6%, and need for open heart surgery 1.5%. Long term complications consisted of all‐cause mortality 2.3%, stroke 1.5%, and left atrial appendage thrombus 2.3%. Reduced complications were noted using micropuncture needles (2.20% vs. 10.14%; p < .0001), a longer duration pericardial drainage, and use of anti‐inflammatory medications (1.58% vs. 8.4%). Oral anticoagulation use decreased from 44.7% to 22.9% post device implantation, and to 8.5% on last clinical follow up.
Conclusions
The LARIAT device is effective in epicardial closure of the left atrial appendage. Improvement in device techniques such as use of micropuncture needle, prophylactic colchicine, and maintenance of a pericardial drain have helped improve safety over time.</description><subject>atrial appendage</subject><subject>Colchicine</subject><subject>Effusion</subject><subject>epicardial appendage closure</subject><subject>Heart surgery</subject><subject>Inflammation</subject><subject>lariat</subject><subject>Long term</subject><subject>Patients</subject><subject>Pericarditis</subject><subject>pooled analysis</subject><subject>Safety</subject><subject>Sutures</subject><subject>systematic review</subject><subject>Thrombosis</subject><issn>1045-3873</issn><issn>1540-8167</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp1kU1Lw0AQhoMoWD8O_oMFL3pIu1_Jpt6k-EnBQ_UcJpvZkpImcXdjyd0f7qb1JDiXGWaed2bgjaIrRqcsxGyjccoSJvhRNGGJpHHGUnUcaiqTWGRKnEZnzm0oZSKlyST6XoFBPxBoSoLGVBr0QFpDajSegLcV1AS6DpsS1kh03breIuld1ayDhmAXFLYcKdf7ceQasOOwxK9K4x1ZDc7jFnyliQ0t3O1P6d5abDxxHnzvLqITA7XDy998Hn08PrwvnuPl29PL4n4ZayEoj5XRFCAVhRAylahoEQIyKCjnUtJMJEapeVnModDCMFEomZZoKAeuynLOxXl0c9jb2fazR-fzbeU01jU02PYu54mUmVI0pQG9_oNu2t424btAJZnMeCbGhbcHStvWOYsm72y1BTvkjOajH3nwI9_7EdjZgd1VNQ7_g_nr4uGg-AEIwI33</recordid><startdate>202108</startdate><enddate>202108</enddate><creator>Sabzwari, Syed Rafay Ali</creator><creator>Mehta, Nikhil A.</creator><creator>Garg, Lohit</creator><creator>Racharla, Lekha</creator><creator>Kurtz, Emilee</creator><creator>Afzal, Muhammad R.</creator><creator>Turagam, Mohit K.</creator><creator>Lakkireddy, Dhanunjaya</creator><general>Wiley Subscription Services, Inc</general><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-9387-4369</orcidid><orcidid>https://orcid.org/0000-0002-3343-7618</orcidid><orcidid>https://orcid.org/0000-0001-5971-2158</orcidid></search><sort><creationdate>202108</creationdate><title>Safety and efficacy of left atrial appendage closure using an epicardial suture snaring device: Systematic review and current status</title><author>Sabzwari, Syed Rafay Ali ; Mehta, Nikhil A. ; Garg, Lohit ; Racharla, Lekha ; Kurtz, Emilee ; Afzal, Muhammad R. ; Turagam, Mohit K. ; Lakkireddy, Dhanunjaya</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3302-7fc0aa63b33464e70bbbba8ab022440835f779db9abc3f13b746def02a27dd923</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>atrial appendage</topic><topic>Colchicine</topic><topic>Effusion</topic><topic>epicardial appendage closure</topic><topic>Heart surgery</topic><topic>Inflammation</topic><topic>lariat</topic><topic>Long term</topic><topic>Patients</topic><topic>Pericarditis</topic><topic>pooled analysis</topic><topic>Safety</topic><topic>Sutures</topic><topic>systematic review</topic><topic>Thrombosis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sabzwari, Syed Rafay Ali</creatorcontrib><creatorcontrib>Mehta, Nikhil A.</creatorcontrib><creatorcontrib>Garg, Lohit</creatorcontrib><creatorcontrib>Racharla, Lekha</creatorcontrib><creatorcontrib>Kurtz, Emilee</creatorcontrib><creatorcontrib>Afzal, Muhammad R.</creatorcontrib><creatorcontrib>Turagam, Mohit K.</creatorcontrib><creatorcontrib>Lakkireddy, Dhanunjaya</creatorcontrib><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of cardiovascular electrophysiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sabzwari, Syed Rafay Ali</au><au>Mehta, Nikhil A.</au><au>Garg, Lohit</au><au>Racharla, Lekha</au><au>Kurtz, Emilee</au><au>Afzal, Muhammad R.</au><au>Turagam, Mohit K.</au><au>Lakkireddy, Dhanunjaya</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Safety and efficacy of left atrial appendage closure using an epicardial suture snaring device: Systematic review and current status</atitle><jtitle>Journal of cardiovascular electrophysiology</jtitle><date>2021-08</date><risdate>2021</risdate><volume>32</volume><issue>8</issue><spage>2189</spage><epage>2198</epage><pages>2189-2198</pages><issn>1045-3873</issn><eissn>1540-8167</eissn><abstract>Introduction
The LARIAT epicardial suture snaring device has been fraught with technical challenges and procedural complications. Over time, technique modification and improved operator experience have helped overcome many of these challenges.
Methods and Results
Studies reporting left atrial appendage epicardial closure over a 12‐year period from 2009 to 2020 were evaluated. The primary efficacy outcome evaluated was left atrial appendage closure with residual flow ≤1 mm. Safety outcomes evaluated were periprocedural and long term complications after device placement. Nine studies consisting of 1430 patients were included in this analysis, of which 1386 (97%) underwent successful device placement. The mean age was 69.3 years, with a mean CHADS2‐VASC score of 3.78. Primary efficacy end point was achieved in 95.8% patients immediately after device placement, and in 92.8% patients on long term follow‐up. Early procedural complications consisted of pericardial effusion 5.6%, cardiac perforation 2.7%, pericarditis 2.6%, and need for open heart surgery 1.5%. Long term complications consisted of all‐cause mortality 2.3%, stroke 1.5%, and left atrial appendage thrombus 2.3%. Reduced complications were noted using micropuncture needles (2.20% vs. 10.14%; p < .0001), a longer duration pericardial drainage, and use of anti‐inflammatory medications (1.58% vs. 8.4%). Oral anticoagulation use decreased from 44.7% to 22.9% post device implantation, and to 8.5% on last clinical follow up.
Conclusions
The LARIAT device is effective in epicardial closure of the left atrial appendage. Improvement in device techniques such as use of micropuncture needle, prophylactic colchicine, and maintenance of a pericardial drain have helped improve safety over time.</abstract><cop>Hoboken</cop><pub>Wiley Subscription Services, Inc</pub><doi>10.1111/jce.15132</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-9387-4369</orcidid><orcidid>https://orcid.org/0000-0002-3343-7618</orcidid><orcidid>https://orcid.org/0000-0001-5971-2158</orcidid></addata></record> |
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| source | Wiley Online Library Journals Frontfile Complete |
| subjects | atrial appendage Colchicine Effusion epicardial appendage closure Heart surgery Inflammation lariat Long term Patients Pericarditis pooled analysis Safety Sutures systematic review Thrombosis |
| title | Safety and efficacy of left atrial appendage closure using an epicardial suture snaring device: Systematic review and current status |
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