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Published on: July 7, 2016
Acute Feasibility of Vacuum-Assisted Catheter-Based Left Atrial Appendage Inversion in a Swine Model
Muhammad Ali1, Brad Farrell2, Khaldoun Ali3
1Kardiologische Praxis, Kattowitzer Str. 191 B, 38226 Salzgitter, Germany.
Background:
The left atrial appendage (LAA) is the predominant site of thrombus formation in atrial fibrillation. Current percutaneous LAA occlusion devices require permanent implants. A catheter-based, non-implant mechanical inversion strategy may offer an alternative approach to stroke prevention.
Objectives:
To assess the feasibility of vacuum-assisted catheter-based inversion of the LAA using transseptal aspiration in a swine model.
Methods:
A 59-kg domestic swine underwent transseptal access via the right femoral vein under fluoroscopy, transesophageal echocardiography (TEE), and intracardiac echocardiography (ICE). A 22-F aspiration catheter was advanced into the left atrium and positioned at the LAA apex. Negative pressure was generated manually with a 60-mL syringe attached to the aspiration port, and sequential suction-traction maneuvers were performed to induce LAA inversion. Procedural feasibility, hemodynamic stability, imaging changes, and gross pathology were assessed.
Results:
LAA suction and inversion were feasible. Sequential negative pressure applications resulted in complete inversion, confirmed by multiplane TEE. A mild, non-hemodynamically significant pericardial effusion occurred. Necropsy showed focal apex injury consistent with catheter stiffness and suction forces.
Conclusions:
Catheter-based vacuum-assisted LAA inversion was technically feasible in this acute swine experiment. However, chronic survival studies are required to evaluate durability of inversion, tissue healing, thrombogenicity, and long-term safety before clinical translation can be considered.
