device design dictates closure success watchman flx and ... 0830-1030/simon cc lam.pdf · /...
TRANSCRIPT
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Device Design Dictates Closure Success – Watchman FLX and other New Generation
LAAO Devices
FACC
/ Cardiovascular Center Frankfurt, Germany
Hong Kong College of Cardiology 28th Annual Scientific Congress 4 July 2020 (Saturday) Atrial Fibrillation & Antithrombotic Symposium
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Closure Success
• Complete sealing without Leak
• Complication-free procedure
• Free from late complications including DRT
• Good long term results
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FDA Indications - to reduce the risk of thromboembolism from the left atrial appendage in patients with non-valvular atrial fibrillation who are at increased risk for stroke and systemic embolism based on CHADS2 or CHA2DS2-VASc scores, are deemed by their physicians to be suitable for warfarin; and have an appropriate rationale to seek a non-pharmacologic alternative to warfarin, taking into account the safety and effectiveness of the device compared to warfarin.
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Watchman • minimal functional LAA length at least = device diameter
Device Size Selection - WATCHMAN
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RAO 30 CRAN 20
RAO 30 CAU 20
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Ostium 20-23mm Watchman #27mm
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Delivery Sheath – LAA alignment
• Watchman is more forgiving regarding sheath position/orientation
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Delivery Sheath – Precautions for Deep Seating with inadequate LAA Depth
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Boston Scientific WATCHMAN FLX
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Atraumatic FLX-Ball design and Implantation technique
Watchman FLX has less metal –
366mm2 24mm FLX device vs 804mm2 25mm AMULET
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RAO 30 CRAN 20 Ostium 22mm RAO 30 CAU 20 Ostium 27mm
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WATCHMAN FLX 35mm
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WATCHMAN FLX 35mm
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WATCHMAN FLX 35mm
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WATCHMAN FLX 35mm
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WATCHMAN FLX 35mm
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WATCHMAN FLX 35mm
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WATCHMAN FLX 35mm
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WATCHMAN FLX 35mm
LAA ostium
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Plane of max diameter
FLX release criteria Size / Compression
Anchors sit on these straight beams
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WATCHMAN FLX 24mm
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WATCHMAN FLX 24mm
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WATCHMAN FLX 24mm
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WATCHMAN FLX 24mm
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Proximal anchors may be shadowed by the geometry
Distal anchors doing most of the work, but also could have some shadowing issues near the distal radius
Distal anchors prominent
Proximal anchors prominent
Marshmallow
Bell Shape
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Abbott AMULET
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Sheath & device
AMULET
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Device Size Selection - Amulet Maximum Landing
Zone Width (mm)
Amulet™Device Size
Lobe Length (mm)
Minimum LAA Depth
(mm)
Disc Diameter
(mm) Sheath Diameter
11.0-13.0 16 7.5 ≥ 10 22
12 F or
14 F (with adaptor)
13.0-15.0 18 7.5 ≥ 10 24
15.0-17.0 20 7.5 ≥ 10 26
17.0-19.0 22 7.5 ≥ 10 28
19.0-22.0 25 10 ≥ 12 32
22.0-25.0 28 10 ≥ 12 35
14 F 25.0-28.0 31 10 ≥ 12 38
28.0-31.0 34 10 ≥ 12 41
Disc Diameter
Lobe Length
Device Size 53
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Landing Zone 25mm AMULET #28mm
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Special LAA Morphology • Small LAA
• LAA with multiple lobes and restrictive septum
• Special design of LAmbre Device
Size: 16-36mm Cover 4-6mm larger
Size: 16-26mm Cover 12mm larger
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• ACP/LAMBRE in poor defined landing zone/chicken wing anatomy with short neck – Sandwich technique • overcome challenging anatomies
• extreme chicken wing type
• secured position
• forgiving extreme angles
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TEE 135 correlates with RAO 30 CRAU 20
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Watchman FLX – Anterior Chicken Wing Anatomy
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Watchman FLX Watchman
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PINNACLE FLX Study
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CHAMPION-AF Study
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WATCH-TAVR Study
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CATALYST Study
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LAA Closure Devices – Checklist
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CBAS® Heparin Surface •The CBAS® Heparin Surface is utilized to bind heparin molecules to the ePTFE via a proprietary covalent end-point attachment mechanism
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Cormos LAA Occluder
In vivo study: Animal model (Started in March 2019) FIM 6/2020
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Conclusion
• Advances in device design facilitate LAA closure
• Implantation techniques, safety precautions and procedural experiences remain as the basis for closure success
• Eg. Watchman FLX – new design features further optimize closure efficacy and safety
• Ongoing clinical trials – eg. PINNACLE FLX, CHAMPION AF, CATALYST
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Thank you!
See you on 17-18 Oct 2020!