Minimally invasive surgical implantation of the percutaneous left atrial appendage transcatheter occlusion device: initial experience in a canine model.

Abstract

OBJECTIVE: Atrial fibrillation (AF) is a significant cause of thromboembolism and stroke. Left atrial appendage (LAA) occlusion is associated with a decreased risk of stroke in patients with AF. Percutaneous implantation of the percutaneous LAA transcatheter occlusion (PLAATO) device has shown reduction in stroke risk and decreased need for anticoagulation. A surgical method of PLAATO implantation is proposed for its utility and efficacy in cardiac surgical procedures, where LAA occlusion is indicated as a primary procedure or as an adjunct. We describe a surgical method for PLAATO deployment in an experimental model that simulates various operative scenarios including right minithoracotomy, right video-assisted thoracoscopic, or median sternotomy. METHODS: The PLAATO LAA occlusion device was deployed into the LAA in six dogs using a right minithoracotomy incision and catheter deployment via direct left atrial access. Intracardiac echocardiography and left atrial angiography were used to size, position, and verify proper deployment of the device. RESULTS: Successful PLAATO deployment was achieved in six of the six dogs. One dog required replacement of an undersized device. One dog required replacement of an oversized device. Four dogs required minor repositioning for optimal positioning. Complete flush occlusion of the LAA was achieved in three dogs; the other three dogs had trace leak by LAA angiography. CONCLUSIONS: Experimental surgical implantation of the PLAATO device produces stable and complete occlusion of the LAA. Potential surgical indications for PLAATO implantation include patients with AF where a percutaneous approach to LAA occlusion is contraindicated or in patients with AF who require concurrent cardiac surgery.