LAA closure with the LAmbre device
The LAAC procedure was performed under local anaesthesia. Transseptal
puncture was performed via right femoral venous access under
fluoroscopic guidance. The sizes of the landing zone and the orifice
were measured from LAA angiography at the right anterior oblique and
caudal projection. The appropriate LAmbre size was selected on the basis
of the intraoperative angiographic and preoperative TEE measurements.
The size of the implant was 4 to 8 mm larger than the measured LAA
orifice based on the clinical judgement of the operators. The CM was
described as previously reported14. In brief, the
delivery sheath was placed in the proximal part of the LAA. The distal
umbrella was released into the LAA by stepwise pushing out of the device
from the delivery sheath. Subsequently, the sheath was withdrawn to
expose the proximal cover. The umbrella was adjusted to open as fully as
possible. In the MM, the distal umbrella was initially half deployed
outside of the LAA (defined as
when
a radio-opaque marker of the LAmbre device was located between two
distal marker bands at the end of the delivery sheath and it was closer
to the proximal marker band) and then gently “en-bloc” advanced into
the proximal part of the LAA. Complete deployment of the umbrella to the
landing zone was subsequently achieved by pushing out the device from
the delivery sheath (Figure 2). The manipulation to expose the cover was
the same as that for the CM. A fully open umbrella was defined as when
the nadir of the U-shaped hooks was at the same level as the
radio-opaque marker connecting the umbrella and cover in fluoroscopic
imaging (Figure 1B). Stability was confirmed by the tug test. The
position of the device and any presence of peri-device leakage were
assessed by fluoroscopy and two-dimensional TEE (0°, 45°, 90°, and 135°)
and following three-dimensional TEE under local laryngeal anaesthesia
with tetracaine. Patients who could not tolerate a TEE examination were
sedated with etomidate and fentanyl. Recapture and/or resizing of the
device was attempted unless the device was in a satisfactory position
and no major peri-device leakage (leakage ≤3 mm) was achieved. The
activated clotting time was adjusted to maintain 250 to 350 s during the
procedure.