Page 37 - Journal of Structural Heart Disease Volume 4, Issue 2

Meeting Abstracts
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removing it from the prosthesis, ROSC was observed. Afterwards, using a 18x30 loop and 16F sca old, device was removed completely. Time from embolisation and cardiac arrest to ROSC was about 30 minutes. The device was snared during heart massage, which was continued without any interruptions for the whole period of cardiac arrest. This might have contributed to survival. The patient was dis- charged week later with no neurological losses.
Learning Points of the Procedure: We suspect that the morphology of chicken wing might have caused the device to only have limited area of contact with LAA walls, as can be observed on Fig 1.B. Even though the compression was within the desired range, outer parts of the device didn’t expand fully because the volume of LAA was not proportional to the ostium size. The di cult anatomy of LAA can increase the risk of device migration. Further studies are needed to evaluate the relation between various LAA morphologies and risk of device embolisation.
PREOPERATIVE WATCHMAN AND AMPLATZER AMULET OCCLUDER SIZING BY CARTO XP Corinna Brenner1, Tobias Haber1, Johannes Härtig2, Juraj Melichercik2, Bruno Ismer1, Nikolaus A. Haas3
1 Peter Osypka Institute for Pacing and Ablation at O enburg University of Applied Sciences, Germany
2 MediClin Heart Center Lahr/Baden, Germany
3 Ludwig Maximilian University of Munich, Germany
Background: Cardiac closure systems are used to manage anatom- ical anomalies and malformations of the heart and the associated pathological e ects. In patients su ering from atrial brillation (AF) left atrial appendage (LAA) is the main source for thrombus forma- tion and embolization. Currently, to select a particular LAA occluder size, several dimensions from uoroscopy and TEE imaging have to be measured intraoperatively, depending on the chosen make and model.
Objective: The aim is to enable a precise preoperative determination of individual LAA occluder size using the CARTOMERGE image inte- gration tool which is a feature of the CARTO XP electro-anatomical mapping system.
Methods: We compared conventional intraoperative uoroscopy and/or TEE guided selection of LAA occluders with preoperative CARTOMERGE selection in 40 consecutive patients (24 m, 16 f, age: 69.6±8.5 years) receiving Watchman (n=22) or Amplatzer Amulet (n=18) devices. CHA2DS2-VASc Score was 3.6±1.9 and HAS-BLED- Score was 3.4±1.2. LAA-morphologies were Chicken Wing (50.0%), Cauli ower (25.0%), Windsock (17.5%) and Cactus (5.0%). During implantation 11 of the patients (27.5%) were in AF. Routine cardiac CT scans were imported into CARTOMERGE for segmentation of the left atrium. The resulting volume images (VI) and slice images (SI) were adjusted in their three dimensional orientation to t the manufactur- er’s sizing recommendations. Subsequently, the match between pre- and intraoperative sizing was compared with the actually implanted device size.
Results: In the Watchman group, preoperative VI corresponded with 43.6% (7/16) and SI with 40.0% (8/20), while intraoperative uoros- copy corresponded with 12.5% (2/16) and TEE with 30.0% (6/20) of all actually implanted devices. According to clinical routine an aberra- tion of one size is commonly used. After including one additional size to the estimation, VI corresponded with 87.5% (14/16), SI with 90.0% (18/20), while uoroscopy corresponded with 87.5% (14/16) and TEE with 75.0% (15/20) of all actually implanted occluders. The remaining were selected empirically.
In the Amplatzer Amulet group, preoperative VI corresponded with 50.0% (8/16) and SI with 44.4% (8/18), while intraoperative uo- roscopy corresponded with 61.1% (11/18) of all actually implanted devices. According to clinical routine an aberration of one size is com- monly used. After including one additional size to the estimation, VI corresponded with 68.8% (11/16), SI with 83.3% (15/18), while uo- roscopy corresponded with 100.0% (18/18) of all actually implanted occluders. The remaining were selected empirically. Postoperatively in the Amplatzer group, one embolization and two dislocations occurred were observed and one patient died during follow-up.
Conclusion: In the 40 consecutive patients, preoperative utilisation of CARTOMERGE was found to be feasible and more accurate than conventional intraoperative uoroscopy and/or TEE based sizing of Watchman occluders but less precise for the Amplatzer Amulet sys- tem. Larger studies have to be done.
Journal of Structural Heart Disease, April 2018
Volume 4, Issue 2:56-65