Results Generated From:
Embase <1980 to 2012 Week 23>
Embase (updates since 2012-05-31)
<1>
Accession Number
2012305494
Authors
Munkholm-Larsen S. Cao C. Yan T.D. Pehrson S. Dixen U.
Institution
(Munkholm-Larsen, Pehrson, Dixen) University of Copenhagen, Copenhagen,
Denmark
(Munkholm-Larsen, Cao, Yan) Systematic Review Group, Baird Institute for
Applied Heart and Lung Surgical Research, Sydney, NSW, Australia
(Pehrson) Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
(Dixen) Hvidovre University Hospital, Copenhagen, Denmark
Title
Percutaneous atrial appendage occlusion for stroke prevention in patients
with atrial fibrillation: A systematic review.
Source
Heart. 98 (12) (pp 900-907), 2012. Date of Publication: June 2012.
Publisher
BMJ Publishing Group (Tavistock Square, London WC1H 9JR, United Kingdom)
Abstract
This review aims to evaluate systematically the safety and efficacy of
percutaneous left atrial appendage occlusion (PLAAO) in stroke prevention
for patients with atrial fibrillation (AF). A systematic review of
peer-reviewed journals on PLAAO before June 2011 was performed on three
electronic databases. Fourteen studies were identified for evaluation.
Overall, implantation was successful in 93% of all cases. Periprocedural
mortality and stroke rates were 1.1% and 0.6%, respectively. The
incidences of pericardial effusion/cardiac tamponade and device
embolisation were 4% and 0.7%, respectively. At the time of the latest
follow-up (up to 40 months), the overall incidence of stroke among all
studies was 1.4% per annum. Existing evidence suggests that PLAAO is a
relatively safe treatment for patients with AF. However, there is a need
for further evaluation of its efficacy in the form of large and
well-designed randomised controlled trials.
<2>
Accession Number
22294530
Authors
Alreja G. Bugano D. Lotfi A.
Institution
(Alreja) Baystate Medical Center, Tufts University School of Medicine, 759
Chestnut Street, Springfield, MA 01089, USA.
Title
Effect of remote ischemic preconditioning on myocardial and renal injury:
meta-analysis of randomized controlled trials.
Source
The Journal of invasive cardiology. 24 (2) (pp 42-48), 2012. Date of
Publication: Feb 2012.
Abstract
The purpose of this study was to assess the effect of remote ischemic
precondition (RIPC) on the incidence of myocardial and renal injury in
patients undergoing cardiovascular interventions as measured by
biomarkers. Clinical data were pooled to evaluate the usefulness of RIPC
to benefit clinical outcomes. Debate exists regarding the merit of using
RIPC for patients undergoing cardiovascular interventions. Systematic
review and meta-analysis of prospective randomized clinical trials of
patients undergoing cardiovascular interventions who received RIPC versus
control were performed. Two independent reviewers selected articles from
MEDLINE, EMBASE, SCOPUS, Cochrane, ISI Web of Science, and BIREME, and
through hand search of relevant reviews and meeting abstracts upon
agreement. Surrogate markers of myocardial (troponin T or I and CK-MB) and
renal (serum creatinine) injury for primary outcomes were abstracted.
Final pooled analysis from 17 clinical trials showed significant
heterogeneity of results and no relevant publication bias. Patients
receiving RIPC had lower levels of markers of myocardial injury in the
first few days after surgery (standardized mean difference [SMD], 0.54;
95% confidence interval [CI], -1.01 to -0.08; P=.01) with highly
heterogeneous results (I2 = 93%). A lower incidence of perioperative
myocardial infarction (7.9% RIPC vs 13.9% placebo; RR, 0.56; 95% CI,
0.37-0.84; P=.005; I2 = 0%) was also noted. In patients undergoing
abdominal aortic aneurysm repair, RIPC when compared to control also
decreased renal injury (SMD, 0.28; 95% CI, -0.49 to -0.08; P=.007; I2 =
51%). RIPC appears to be associated with a favorable effect on serological
markers of myocardial and renal injury during cardiovascular
interventions. Larger trials should be conducted to substantiate this
initial impression.
<3>
Accession Number
2012307949
Authors
Boriani G. Gardini B. Diemberger I. Bacchi Reggiani M.L. Biffi M.
Martignani C. Ziacchi M. Valzania C. Gasparini M. Padeletti L. Branzi A.
Institution
(Boriani, Gardini, Diemberger, Bacchi Reggiani, Biffi, Martignani,
Ziacchi, Valzania, Branzi) Institute of Cardiology, University of Bologna,
Via Massarenti 9, 40138 Bologna, Italy
(Gasparini) Electrophysiology and Pacing Unit, Cardiology Department,
IRCCS Istituto Clinico Humanitas, Rozzano, Milano, Italy
(Padeletti) Department of Heart and Vessels, University of Florence,
Florence, Italy
Title
Meta-analysis of randomized controlled trials evaluating left ventricular
vs. biventricular pacing in heart failure: Effect on all-cause mortality
and hospitalizations.
Source
European Journal of Heart Failure. 14 (6) (pp 652-660), 2012. Date of
Publication: June 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Aim Randomized controlled trials (RCTs) showed that biventricular (BiV)
pacing reduces heart failure (HF) hospitalizations and mortality in
patients with New York Heart Association (NYHA) class IIIIV HF, left
ventricular (LV) dysfunction, and wide QRS. We performed a systematic
review and meta-analysis of the RCTs comparing LV-only vs. biventricular
(BiV) pacing in candidates for cardiac resynchronization therapy
(CRT).Methods and resultsThe systematic review selected five RCTs (out of
1888 analysed reports) with a cumulative number of 372 patients randomized
to BiV pacing and 258 to LV-only pacing. The meta-analysis shows that BiV
pacing is not superior to LV-only pacing and that these two pacing
modalities do not differ with regard to death or heart transplantation
[LV-only vs. BiV pacing odds ratio (OR) 1.24, 95 confidence interval (CI)
0.572.70 with the fixed effect model, OR 1.25, 95 CI 0.483.24 with the
random effect model]. Specific data on hospitalizations were available
only in two RCTs with a cumulative number of 127 patients randomized to
BiV and 123 to LV-only pacing. The meta-analysis shows that BiV pacing is
not superior to LV-only pacing and that these two pacing modalities do not
differ with regard to this outcome (LV-only vs. BiV pacing OR 0.86, 95 CI
0.491.50 with the fixed effect model, OR 0.86, 95 CI 0.491.50 with the
random effect model).ConclusionsBiventricular pacing is not superior to
LV-only pacing, and these two pacing modalities appear to achieve similar
efficacy in candidates for CRT for moderate to severe HF, in terms of
all-cause mortality and hospitalizations during follow-up. 2012 The
Author.
<4>
Accession Number
2012301018
Authors
Liou H.-L. Shih C.-C. Chao Y.-F.C. Lin N.-T. Lai S.-T. Wang S.-H. Chen
H.I.
Institution
(Liou) Department of Nursing, Taipei Veterans General Hospital, Taipei,
Taiwan (Republic of China)
(Shih) Institue of Clinical Medicine, National Yang Ming Medical
University; Division of Cardiovascular Surgery, Taipei Veterans General
Hospital, Taipei, Taiwan (Republic of China)
(Chao) Department of Nursing, Mackay Medical College, New Taipei City,
Taiwan (Republic of China)
(Lin) Department of Microbiology Immunology and Molecular Medicine, Tzu
Chi University, Hualien, Taiwan (Republic of China)
(Lai) Division of Cardiovascular Surgery, Taipei Veterans General
Hospital, Taipei, Taiwan (Republic of China)
(Wang) Department of Anesthesiology, Veterans General Hospital, Taipei,
Taiwan (Republic of China)
(Chen) Institue of Physiological and Anatomical Medicine, Tzu Chi
University, Hualien, Taiwan (Republic of China)
Title
Inflammatory response to colloids compared to crystalloid priming in
cardiac surgery patients with cardiopulmonary bypass.
Source
Chinese Journal of Physiology. 55 (3) (pp 1-9), 2012. Date of Publication:
2012.
Publisher
Chinese Physiological Society (Taipei11529Taiwan (Republic of China))
Abstract
Cardiac surgery with cardiopulmonary bypass (CPB) induces a systemic
inflammatory response syndrome that may contribute to postoperative
morbidity and mortality. We investigated the inflammatory responses to
colloids compared to crystalloid priming in cardiac surgery patients with
cardiopulmonary bypass. Thirty patients undergoing coronary artery bypass
grafting (CABG) preparing for CPB were randomized into Ringer's solution
(RS), 10% hydroxyethyl starch (HES) or 25% human albumin (HA) group. Serum
concentrations of tumor necrosis factor-alpha (TNF-alpha),
interleukin-1beta (IL-1beta), interleukin-6 (IL-6) and interleukin-10
(IL-10) were measured before CPB, at the end of CPB and 1, 6 and 12 h
after CPB. Serum C-reactive protein (CRP) was determined pre-operatively
and then daily for 2 days. Body-weight gain was significantly decreased on
the day after surgery in the HES group than in the RS group. Volume
priming in CPB for CABG patients using HA or HES preparation had less
tendency for intense inflammatory response with lower levels of TNF-alpha,
IL-1beta, IL-6 and higher levels of IL-10 compared to patients treated
with RS. HES prime had lower levels of circulating CRP than in patients
treated with HA or Ringer prime on the second post-operative day. Our data
indicate that volume priming using colloid during CPB in CABG patients
might exert beneficial effects on inflammatory responses. 2012 by The
Chinese Physiological Society and Airiti Press Inc.
<5>
Accession Number
2012286748
Authors
Newton P.J. Davidson P.M. Krum H. Ollerton R. Macdonald P.
Institution
(Newton, Davidson) Centre for Cardiovascular and Chronic Care, Faculty of
Nursing, Midwifery and Health, University of Technology Sydney, Australia
(Newton, Ollerton) University of Western Sydney, Sydney, Australia
(Davidson) St Vincent's and Mater Health, Sydney, Australia
(Krum) Department of Epidemiology and Preventive Medicine, Monash
University, Melbourne, Australia
(Macdonald) St Vincent's Hospital, Sydney, Australia
(Macdonald) Victor Chang Cardiac Research Institute, Sydney, Australia
Title
The Acute Haemodynamic Effect of Nebulised Frusemide in Stable, Advanced
Heart Failure.
Source
Heart Lung and Circulation. 21 (5) (pp 260-266), 2012. Date of
Publication: May 2012.
Publisher
Elsevier Ltd (Langford Lane, Kidlington, Oxford OX5 1GB, United Kingdom)
Abstract
Purpose: To assess the acute haemodynamic effects of nebulised frusemide
in a stable advanced heart failure population. Procedure: In this
randomised, double blind, placebo controlled trial, people with stable,
advanced heart failure undergoing right heart catheterisation were
randomised to receive either 40. mg (4. ml) of nebulised frusemide or 4.
ml of normal saline. Following inhalation of the study medication,
subjects' pulmonary pressures were recorded every 15. min for 1. h.
Findings: There were no significant changes in the weighted average time
course data of the subjects (n= 32) in either group over the study period,
in particular no differences were observed in haemodynamic parameters
between the two groups. Weighted average pulmonary capillary wedge
pressure after 60. min in the frusemide group was 22.5 (SD 6.5) mmHg (n=
14) compared to the placebo group's 24.0 (SD 7.3) mmHg (n= 18), p= 0.55.
The frusemide group had a significantly greater change in the median
volume of urine in the bladder over the study period (186. ml IQR
137.8-260.8) compared to the placebo group (76. ml IQR 39.0-148.0) p=
0.02. Conclusion: This study showed that nebulised frusemide had no
significant clinical effect on the haemodynamic characteristics of the
subjects. 2012 Australian and New Zealand Society of Cardiac and Thoracic
Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand
(CSANZ).
<6>
Accession Number
2012299171
Authors
Larsen B.M.K. Goonewardene L.A. Joffe A.R. Van Aerde J.E. Field C.J.
Olstad D.L. Clandinin M.T.
Institution
(Larsen) Nutrition Service, Alberta Health Services, Edmonton Area, Canada
(Larsen, Field, Olstad, Clandinin) Alberta Institute for Human Nutrition,
University of Alberta, Canada
(Larsen, Field, Clandinin) Department of Medicine, University of Alberta,
Canada
(Goonewardene, Field, Olstad, Clandinin) Department of Agricultural, Food
and Nutritional Science, University of Alberta, Canada
(Goonewardene) Alberta Agriculture and Rural Development, Government of
Alberta, Canada
(Joffe, Van Aerde) Department of Pediatrics, University of Alberta, Canada
(Joffe, Van Aerde) Stollery Children's Hospital, University of Alberta,
Canada
Title
Pre-treatment with an intravenous lipid emulsion containing fish oil
(eicosapentaenoic and docosahexaenoic acid) decreases inflammatory markers
after open-heart surgery in infants: A randomized, controlled trial.
Source
Clinical Nutrition. 31 (3) (pp 322-329), 2012. Date of Publication: June
2012.
Publisher
Churchill Livingstone (1-3 Baxter's Place, Leith Walk, Edinburgh EH1 3AF,
United Kingdom)
Abstract
Background & aims: This study assessed the effects of administering a
lipid emulsion containing eicosapentaenoic and docosahexaenoic acid before
and after open-heart surgery on cytokine production and length of hospital
stay in infants. Methods: Thirty-two infants (40 +/- 2.3 weeks gestational
age; 10.6 days at time of surgery) undergoing open-heart surgery with
cardiopulmonary bypass were randomized to receive an intravenous lipid
emulsion with (treatment) or without (control) eicosapentaenoic and
docosahexaenoic acid in this prospective, randomized, double-blind,
controlled trial. Results: Mean plasma TNF-alpha concentration was
significantly (p = 0.003) lower in the treatment (5.9 pg/mL) compared to
the control group (14.8 pg/mL). In infants without sepsis, plasma
TNF-alpha did not differ according to treatment, however when sepsis
developed, mean plasma TNF-alpha was 21.1 pg/mL and 1.5 pg/mL (p = 0.0007)
in control and treatment groups, respectively. Plasma TNF-alpha was
positively correlated with length of hospital stay in the control group (p
= 0.01), and negatively correlated with length of stay in the treatment
group (p = 0.004), with a significant time by treatment interaction (p =
0.02). Conclusions: Providing a lipid emulsion containing eicosapentaenoic
and docosahexaenoic acid reduces TNF-alpha concentrations in infants
undergoing open-heart surgery. Lipid emulsions containing eicosapentaenoic
and docosahexaenoic acid may ameliorate the inflammatory response among
critically ill infants.This trial was registered at clinicaltrials.gov as
NCT00336908. 2011 Elsevier Ltd and European Society for Clinical
Nutrition and Metabolism.
<7>
Accession Number
2012299653
Authors
Gu W.-J. Wu Z.-J. Wang P.-F. Aung L.H.H. Yin R.-X.
Institution
(Gu, Aung, Yin) Department of Cardiology, Institute of Cardiovascular
Diseases, The First Affiliated Hospital, Guangxi Medical University, 22
Shuangyong Road, Nanning 530021, Guangxi, China
(Wu) Department of Colorectal and Anal Surgery, The First Affiliated
Hospital, Guangxi Medical University, Nanning, Guangxi, China
(Wang) Department of Orthopaedics, China-Japan Union Hospital, Jilin
University, Changchun, Jilin, China
Title
Intravenous magnesium prevents atrial fibrillation after coronary artery
bypass grafting: A meta-analysis of 7 double-blind, placebo-controlled,
randomized clinical trials.
Source
Trials. 13 , 2012. Article Number: 41. Date of Publication: 20 Apr 2012.
Publisher
BioMed Central Ltd. (Floor 6, 236 Gray's Inn Road, London WC1X 8HB, United
Kingdom)
Abstract
Background: Postoperative atrial fibrillation (POAF) is the most common
complication after coronary artery bypass grafting (CABG). The preventive
effect of magnesium on POAF is not well known. This meta-analysis was
undertaken to assess the efficacy of intravenous magnesium on the
prevention of POAF after CABG.Methods: Eligible studies were identified
from electronic databases (Medline, Embase, and the Cochrane Library). The
primary outcome measure was the incidence of POAF. The meta-analysis was
performed with the fixed-effect model or random-effect model according to
heterogeneity.Results: Seven double-blind, placebo-controlled, randomized
clinical trials met the inclusion criteria including 1,028 participants.
The pooled results showed that intravenous magnesium reduced the incidence
of POAF by 36% (RR 0.64; 95% confidence interval (CI) 0.50-0.83; P =
0.001; with no heterogeneity between trials (heterogeneity P = 0.8,
I<sup>2 </sup>= 0%)).Conclusions: This meta-analysis indicates that
intravenous magnesium significantly reduces the incidence of POAF after
CABG. This finding encourages the use of intravenous magnesium as an
alternative to prevent POAF after CABG. But more high quality randomized
clinical trials are still need to confirm the safety. 2012 Gu et al;
licensee BioMed Central Ltd.
<8>
Accession Number
2012284262
Authors
Tiek J. Remy P. Sabbe T. D'Hont C. Houthoofd S. Daenens K. Fourneau I.
Institution
(Tiek, Sabbe, Houthoofd, Daenens, Fourneau) Department of Vascular
Surgery, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
(Remy, D'Hont) Department of Vascular Surgery, Hopital St. Joseph,
Charleroi, Belgium
Title
Laparoscopic versus open approach for aortobifemoral bypass for severe
aorto-iliac occlusive disease - A multicentre randomised controlled trial.
Source
European Journal of Vascular and Endovascular Surgery. 43 (6) (pp
711-715), 2012. Date of Publication: June 2012.
Publisher
W.B. Saunders Ltd (32 Jamestown Road, London NW1 7BY, United Kingdom)
Abstract
Objectives: To investigate differences between open and laparoscopic
aortobifemoral bypass surgery for aorto-iliac occlusive disease on
postoperative morbidity and mortality. Design: A multicentre randomised
controlled trial. Methods: Between January 2007 and November 2009, 28
patients with severe aorto-iliac occlusive disease (TASC II C or D) were
randomised between laparoscopic and open approach at one community
hospital and one university hospital (TASC = Trans-Atlantic Inter-Society
Consensus on the Management of Peripheral Arterial Disease). Results: The
operation time was longer for the laparoscopic approach (mean 4 h 19 min
(2 h 00 min to 6 h 20 min) vs. 3 h 30 min (1 h 42 min to 5 h 11 min); p =
0.101)). Nevertheless, postoperative recovery and in-hospital stay were
significantly shorter after laparoscopic surgery. Also oral intake could
be restarted earlier (mean 20 h 34 min (6 h 00 min to 26 h 55 min) vs. 43
h 43 min (19 h 40 min to 77 h 30 min); p = 0.00014)) as well as
postoperative mobilisation (walking) (mean 46 h 15 min (16 h 07 min to 112
h 40 min) vs. mean 94 h 14 min (66 h 10 min to 127 h 23 min); p =
0.00016)). Length of hospitalisation was shorter (mean 5.5 days (2.5-15)
vs. mean 13.0 days (7-45); p = 0.0095)). Visual pain scores and visual
discomfort scores were both lower after laparoscopic surgery. Also return
to normal daily activities was achieved earlier. There were no major
complications in both groups. Conclusion: Laparoscopic aortobifemoral
bypass surgery for aorto-iliac occlusive disease is a safe procedure with
a significant decrease in postoperative morbidity and in-hospital stay and
earlier recovery. 2012 European Society for Vascular Surgery. Published
by Elsevier Ltd. All rights reserved.
<9>
Accession Number
2012292073
Authors
Chen Z. Qian J. Ma J. Ge L. Ge J.
Institution
(Chen, Qian, Ma, Ge, Ge) Department of Cardiology, Fudan University,
Zhongshan Hospital, 180 Fenglin Road, Shanghai 200032, China
Title
Effect of gender on repeated coronary artery revascularization after
intra-coronary stenting: A meta-analysis.
Source
International Journal of Cardiology. 157 (3) (pp 381-385), 2012. Date of
Publication: 14 Jun 2012.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Background: As a risk factor of coronary artery disease (CAD), gender
might be associated with the prognosis of percutaneous coronary
intervention (PCI). However, there are conflicting reports in the
literature regarding the role of gender on repeated coronary artery
revascularization after PCI. Objective: This meta-analysis aimed to
determine whether gender influenced the incidence of repeated coronary
artery revascularization after intra-coronary stenting. Methods: We
performed a meta-analysis including 13 randomized controlled trials (a
total of 156,798 patients, including 107,697 men and 49,101 women) that
assessed the results of target vessel revascularization (TVR), target
lesion revascularization (TLR) and major adverse cardiac events (MACE)
after PCI. PUBMED, MEDLINE, EMBASE and the Cochrane Database were searched
for articles published in the last 10 years. Results: There was no
difference in the long-term incidence of TVR between males and females
after PCI (16.68% vs. 16.41%; odds ratio (OR) = 0.94; 95% confidence
intervals (CI): 0.82-1.07; P = 0.36). However, the short-term rate of TVR
after PCI was significantly higher in women than that in men (4.25% vs.
3.83%; OR = 0.91; 95% CI: 0.86-0.97; P < 0.01). Moreover, women had higher
short-term and long-term incidences of MACE than men after PCI
(short-term: 8.02% vs. 5.57%; P < 0.01; long-term: 16.14% vs. 13.72%, P <
0.01). Conclusions: The present data suggested that female sex could
increase the short-term incidence of repeated coronary revascularization
after PCI. However, the long-term rate of repeated coronary
revascularization was similar between male and female patients. 2012
Elsevier B.V. All rights reserved.
<10>
Accession Number
22395336
Authors
Mobius-Winkler S. Sandri M. Mangner N. Lurz P. Dahnert I. Schuler G.
Institution
(Mobius-Winkler) University of Leipzig Heart Center, Leipzig, Germany.
Title
The WATCHMAN left atrial appendage closure device for atrial fibrillation.
Source
Journal of visualized experiments : JoVE. (60) , 2012. Date of
Publication: 2012.
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia, affecting
an estimated 6 million people in the United States (1). Since AF affects
primarily elderly people, its prevalence increases parallel with age. As
such, it is expected that 15.9 million Americans will be affected by the
year 2050 (2). Ischemic stroke occurs in 5% of non-anticoagulated AF
patients each year. Current treatments for AF include rate control, rhythm
control and prevention of stroke (3). The American College of Cardiology,
American Heart Association, and European Society of Cardiology currently
recommended rate control as the first course of therapy for AF (3). Rate
control is achieved by administration of pharmacological agents, such as
beta-blockers, that lower the heart rate until it reaches a less
symptomatic state (3). Rhythm control aims to return the heart to its
normal sinus rhythm and is typically achieved through administration of
antiarrhythmic drugs such as amiodarone, electrical cardioversion or
ablation therapy. Rhythm control methods, however, have not been
demonstrated to be superior to rate-control methods (4-6). In fact,
certain antiarrhythmic drugs have been shown to be associated with higher
hospitalization rates, serious adverse effects (3), or even increases in
mortality in patients with structural heart defects (7). Thus, treatment
with antiarrhythmics is more often used when rate-control drugs are
ineffective or contraindicated. Rate-control and antiarrhythmic agents
relieve the symptoms of AF, including palpitations, shortness of breath,
and fatigue (8), but don't reliably prevent thromboembolic events (6).
Treatment with the anticoagulant drug warfarin significantly reduces the
rate of stroke or embolism (9,10). However, because of problems associated
with its use, fewer than 50% of patients are treated with it. The
therapeutic dose is affected by drug, dietary, and metabolic interactions,
and thus requires detailed monitoring. In addition, warfarin has the
potential to cause severe, sometimes lethal, bleeding (2). As an
alternative, aspirin is commonly prescribed. While aspirin is typically
well tolerated, it is far less effective at preventing stroke (10). Other
alternatives to warfarin, such as dabigatran (11) or rivaroxaban (12)
demonstrate non-inferiority to warfarin with respect to thromboembolic
events (in fact, dabigatran given as a high dose of 150 mg twice a day has
shown superiority). While these drugs have the advantage of eliminating
dietary concerns and eliminating the need for regular blood monitoring,
major bleeding and associated complications, while somewhat less so than
with warfarin, remain an issue (13-15). Since 90% of AF-associated strokes
result from emboli that arise from the left atrial appendage (LAA) (2),
one alternative approach to warfarin therapy has been to exclude the LAA
using an implanted device to trap blood clots before they exit. Here, we
demonstrate a procedure for implanting the WATCHMAN Left Atrial Appendage
Closure Device. A transseptal cannula is inserted through the femoral
vein, and under fluoroscopic guidance, inter-atrial septum is crossed.
Once access to the left atrium has been achieved, a guidewire is placed in
the upper pulmonary vein and the WATCHMAN Access Sheath and dilator are
advanced over the wire into the left atrium. The guidewire is removed, and
the access sheath is carefully advanced into the distal portion of the LAA
over a pigtail catheter. The WATCHMAN Delivery System is prepped, inserted
into the access sheath, and slowly advanced. The WATCHMAN device is then
deployed into the LAA. The device release criteria are confirmed via
fluoroscopy and transesophageal echocardiography (TEE) and the device is
released.
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