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Percutaneous devices for left atrial appendage occlusion: A contemporary review

World Journal of Cardiology 2019年第2期11卷 57-70页

作者： Homam moussa pacha Yasser Al-khadra Mohamad Soud Fahed Darmoch abdulghani moussa pacha M Chadi Alraies MedStar Washington Hospital Center Cleveland Clinic Medicine Institute Beth Israel Deaconess Medical center/Harvard Medical School University Hospital of Mainz Wayne State University Detroit Medical Center Detroit Heart Hospital

Patient with atrial fibrillation(AF) are at risk of developing stroke with the left atrial appendage(LAA) being the most common site for thrombus formation. If left untreated, AF is associated with 4 to 5 folds increase in the risk of ischemic stroke in all age groups. About 5% to 15% of AF patients have atrial thrombi on transesophageal echocardiography, and 91% of those thrombi are located in the LAA in patient with nonrheumatic AF. Although oral anticoagulants are the gold-standard treatment for stroke prevention in patients with non-valvular AF,some patients are at high risk of bleeding and deemed not candidates for anticoagulation. Therefore, LAA occlusion(LAAO) has emerged as alternative approach for stroke prevention in those patients. Surgical LAAO is associated with high rate of unsuccessful closure and recommended only in patients with AF and undergoing cardiac surgery. Percutaneous LAAO uses transvenous access with trans-septal puncture and was first tested using the PLAATO *** is the most common and only Food and Drug Administration(FDA)approved device for LAAO. LAAO using Watchman device is non-inferior to warfarin therapy in preventing ischemic stroke/systemic ***, it is associated with lower rates of hemorrhagic stroke, bleeding and death. Amplatzer is another successful LAAO device that has CE mark and is waiting for FDA approval. Optimal antithrombotic therapy post LAAO is still under debate and highly patient-specific. The aim of this paper is to systematically review the current literature to evaluate the efficacy and safety of different LAAO devices.

关键词： Left atrial appendage Atrial fibrillation Anticoagulation Stroke Mortality

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