Background: The efficacy of interventional therapies aiming at excluding the left atrial appendage (LAA) from systemic circulation on stroke prophylaxis may be compromised owing to suboptimal LAA closure. Additionally, the need for an alternative TE prevention may remain unmet in patients with contraindications to oral anticoagulation whose appendage anatomy is unsuitable for some conventional devices commercially available.
Objective: We aimed at evaluating the feasibility of LAA closure with the novel Gore^® Cardioform Septal Occluder (CSO) in patients with incomplete appendage ligation or anatomical features which do not meet the minimal manufacturer’s requirement for Watchman deployment.
Methods: Eighteen consecutive patients (mean age: 73±7 years; 92% males; CHA2DS2-VASc: 4.2±1.5; HAS-BLED: 3.2±0.9) were included. Trans-oesophageal echocardiography (TEE) was performed within 2 months post-procedure to assess for residual LAA patency.
Results: Eleven patients had incomplete LAA closure following surgical (n=5), or Lariat ligation (n=6). In the remaining 7 patients with an appendage anatomy unsuitable for Watchman deployment, the mean maximal landing zone size and LAA depth were 14.4±1.3mm and 18.6±2.8mm. Successful CSO deployment was achieved in all patients. No peri-procedural complications were documented. Procedure and fluoroscopy times were 47±15min and 16±11min, respectively. Follow-up TEE performed after 58±9 days revealed complete LAA closure in all patients.
Conclusion: Transcatheter LAA closure via a CSO device might be a valid alternative in patients with residual leaks following incomplete appendage ligation or whose LAA anatomy does not meet the minimal anatomical criteria to accommodate a conventional Watchman device.