title: Transcatheter patch occlusion of the left atrial appendage using surgical adhesives in high-risk patients with atrial fibrillation.
abstract: OBJECTIVE
  The efficacy of left atrial appendage (LAA) occlusion using the Transcatheter Patch (TP) (Custom Medical Devices, Athens, Greece) in conjunction with surgical adhesives was assessed.
  
  
  BACKGROUND
  The TP is a bioabsorbable device that can be adjusted for the shape and size of the LAA without the risk of perforation. It is attached by a surgical adhesive and is released in 45 min.
  
  
  METHODS
  Occlusion of the LAA was performed in 20 high-risk patients, 59 to 89 years of age, with atrial fibrillation. A 2-stage polyethylene glycol surgical adhesive was applied to the distal half of the device. Activation of the adhesive was achieved by direct injection of alkaline solution. Fluoroscopy and transesophageal echocardiography only were used for device placement in 17 patients. In 3 patients, angiography was used as well. Follow-up transesophageal echocardiography was performed upon discharge.
  
  
  RESULTS
  The procedure was successful in 17 cases. In the 3 patients in whom angiography was performed, the patch did not attach and was retrieved. In 1 case, the patch was placed beyond the mouth of the appendage, resulting in a residual opening. There was further improvement of the occlusion rate on the follow-up transesophageal echocardiography. There was 1 complication related to the procedure, namely, thrombus was released from the long sheath in the left atrium upon withdrawal and required treatment to be dissolved. No recurrent strokes were reported.
  
  
  CONCLUSIONS
  Occlusion of the LAA by the TP is feasible and effective in most patients with atrial fibrillation at high risk for embolic stroke. Angiography before placement probably affects patch adhesion and is contraindicated.
authors.affiliation: Department of Clinical Therapeutics, University of Athens, Athens, Greece.
authors.forename: Savvas
authors.initials: S
authors.lastname: Toumanides
authors.forename: Eleftherios B
authors.initials: EB
authors.lastname: Sideris
authors.forename: Tullio
authors.initials: T
authors.lastname: Agricola
authors.forename: Spyridon
authors.initials: S
authors.lastname: Moulopoulos
mesh_terms: D020341:Absorbable Implants; D000368:Aged; D000369:Aged, 80 and over; D020517:Atrial Appendage / Q000000981:diagnostic imaging / Q000601:surgery*; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods*; D006348:Cardiac Surgical Procedures; D017548:Echocardiography, Transesophageal; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D014014:Tissue Adhesives / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D014014:Tissue Adhesives