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LAA Clip

Date: 2018-01-10
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Cardiogenic stroke is one of the most serious complications of atrial fibrillation. This kind of clip mechanically close left atrial appendage, and block thrombi generated from LAA. For the patient with ectopic pacemaker from LAA, the clip can also play a role for electrical isolation. The LAA clip can be used together with surgical treatment for AF or stand alone. Its simplicity, safety and effectiveness have been proved with high success rate.


Stroke and LAA

Stroke is one of the top 3 killers that endanger human health. It has high incidence, high morbidity and high mortality. Atrial fibrillation is one of the major causes for ischemic stroke (cerebral infarction). The left atrial appendage is extended from the left atrium. The shape is like a human ear with a blind end. Moreover, the LAA inside contains rich musculi pectinati and trabecular muscle, making its surface uneven. It has been regarded as “our most lethal human attachment”. Due to decreased atrial systolic function, blood stasis and anatomical structure, LAA becomes the most common site of thrombosis. Once the thrombus generated from LAA shed, it could be washed with blood flow into intracranial artery, resulting cerebral infarction-stroke. As reported, patients with non-valvular heart disease and atrial fibrillation, 90% of thrombus are originated from the left atrial appendage. ( In a major study of patients with Afib who had a stroke, more than 90 percent of the clots were found to exist in the LAA.)


Mechanical closure of the LAA

Since 1948 the first resection of the LAA, medical experts have been exploring the best method for LAA exclusion. Traditional ways to treat the LAA include simple ligation or suturing after resection, which always lead to many complications such as bleeding and leak. Mechanical closure is easily to be performed through thoracoscopy or thoracic surgery. The LAA clip will be closed under mechanical pressure. Then the LAA will gradually atrophy. There will be no further thrombosis in the LAA. Thereby the ischemic stroke would be prevented. Mechanical closure of the LAA is recommended by medical experts, it is an optimal treatment for stroke prevention in patients with atrial fibrillation.


LAA Exclusion Procedure (animation)

Left atrial appendage exclusion can be performed through thoracoscopy or thoracic surgery.  During thoracoscopy, a small hole is opened through the chest wall for device implantation.

During open surgery, such as valve replacement or coronary artery grafting, it can be performed under direct vision.


Detailed Procedure:

First, according to the size of the LAA, select the appropriate LAA clip. Then fix the LAA clip onto LAA root through epicardial way. Patients chose minimally invasive ways, the LAA clip should be released under TEE monitoring. The LAA clip should be confirmed that it does not compress the surrounding tissues. After exclusion, the surface between LAA and LA is very smooth. In 60 days the endothelialization would complete at the exclusion surface. At last, the remanent LAA would gradually atrophy due to fibrosis and necrosis.

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