Occluding morphologically complicated left atrial appendage using the small-umbrella LAmbre device

• Published in: BMC cardiovascular disorders Vol. 22; no. 1; pp. 326 - 9
• Main Authors: Zhang, Hong-Da, Yang, Ming, Xing, Yang-Bo, Weng, Si-Xian, Ding, Lei, Ding, Xiao-Tong, Hu, Li-Xing, Qi, Ying-Jie, Yu, Feng-Yuan, Zhang, Jing-Tao, Fang, Pi-Hua, Hua, Wei, Zhang, Shu, Tang, Min
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 23-07-2022; BioMed Central; BMC
• Subjects: Atrial Appendage - diagnostic imaging; Atrial fibrillation; Atrial Fibrillation - complications; Atrial Fibrillation - diagnosis; Atrial Fibrillation - surgery; Cardiac Catheterization - adverse effects; Cardiovascular disease; Cardiovascular instruments, Implanted; Comorbidity; Complications and side effects; Echocardiography; Echocardiography, Transesophageal - adverse effects; Ejection fraction; Embolisms; Fibrillation; Heart atrium; Humans; Ischemia; LAmbre; Left atrial appendage occlusion; Occlusion; Patients; Physiological aspects; Prevention; Retrospective Studies; Risk factors; Septal Occluder Device - adverse effects; Small-umbrella; Stroke; Stroke (Disease); Stroke - complications; Stroke - prevention & control; Testing; Thrombosis; Transient ischemic attack; Treatment Outcome; China; Small-umbrella; Left atrial appendage occlusion; LAmbre; Thrombosis; Atrial fibrillation
• ISSN: 1471-2261; 1471-2261
• DOI: 10.1186/s12872-022-02770-y

Percutaneous left atrial appendage (LAA) occlusion is effective for stroke prevention in patients with atrial fibrillation. LAA can have a complex anatomy, such as multiple lobes or a large orifice, which may render it unsuitable for occlusion using regular devices. We aimed to investigate the feasibility, safety, and short-term efficacy of the small-umbrella LAmbre device for morphologically complicated LAA.
We retrospectively enrolled 129 consecutive patients who underwent LAA occlusion using the LAmbre device; the small-umbrella LAmbre device was used in 30 of these patients. We analyzed patients' characteristics, procedural details, and outcomes.
Twenty-two patients (73.3%) had multilobed (≥ 2) LAA. The umbrella of the occluder was anchored in the branch in 9 patients and in the common trunks of branches in 13 patients. The landing zone and orifice diameters were 19.0 ± 4.39 mm and 27.4 ± 3.95 mm, respectively. The sizes of the umbrella and occluder cover were 22.0 ± 3.42 mm and 34.3 ± 2.75 mm, respectively. At 3-month follow-up transesophageal echocardiography in 24 patients, no peri-device residual flow was reported. Device thrombosis was detected in one patient at 3 months and disappeared after 3 months of anticoagulation. Ischemic stroke occurred in one patient; no other adverse events were reported.
Occlusion of morphologically complicated LAA using the small-umbrella LAmbre device was feasible, safe, and effective in patients with atrial fibrillation in this study. This occluder provides an alternative for patients who cannot be treated with regular-sized LAA occlusion devices.