Left Atrial Appendage Closure – Techniques and Devices
The history of percutaneous occlusion of the left atrial appendage (LAA) for stroke prevention started back in 2001 with the first implantation of the percutaneous LAA transcatheter occlusion system (PLAATO; Appriva Medical, Sunnyvale, CA, USA) . The PLAATO device was a self-expanding nitinol cage covered with a polytetrafluoroethylene membrane, anchoring in the LAA using hooks positioned on the struts of the cage (Fig. 17.1). Despite favorable clinical results with an annual ischemic stroke rate substantially lower than predicted by CHADS2 score (3.8 % vs. 6.6 %) , the manufacturer discontinued the development of the device in 2006. This was the result of the strict and therefore costly requirements of the FDA, which is why approval of the occluder on the American market did not appear possible. But the development of other endo- and epicardial systems for LAA closure continued. This section presents requirements and techniques for the occlusion of the LAA considering commercially available devices to which CE Mark or FDA approval was granted.
KeywordsLeft Atrial Appendage Landing Zone Transseptal Puncture Delivery Catheter Access Sheath
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