ADVERTISEMENT
Left Atrial Appendage Occlusion With the LAmbre Device: First-in-Human in the United States
J INVASIVE CARDIOL 2021;33(8):E670-E671.
Key words: cardiac imaging, left atrial appendage
The left atrial appendage (LAA) is a highly variable anatomical structure, which may pose a challenge to successful LAA occlusion with currently approved technology.1 We present our experience with the compassionate use of the LAmbre LAA closure device (Lifetecha) for a 79-year-old male patient with non-valvular atrial fibrillation and multiple falls who was considered high risk for anticoagulation therapy. Computed tomography (CT) evaluation of the LAA measured 16.3 x 9.6 mm with a depth of 18.2 mm, which the implanting team felt was too small to accommodate a Watchman device (Boston Scientific). The Watchman FLX device was not available at the time. The patient agreed to participate in the compassionate use of the LAmbre device. Institutional review board approval was obtained.
The LAmbre LAA closure device is a self-expanding nitinol device made of a proximal cover (with sewn-in polyethylene terephthalate [PET]) and a distal umbrella, which serves as the anchor in the appendage. The umbrella is made of 8 claws and an additional PET membrane, connected by a central waist (Figure 1). The LAmbre device is available in 15 sizes, ranging from 16 to 36 mm (for both the cover and the umbrella) and it can be custom made for special circumstances.2
The procedure was performed in standard fashion. Utilizing a 10 Fr double-curve LAmbre delivery sheath, a 22 mm umbrella/20 mm cover LAmbre device was placed in the LAA with excellent seal and stability (Figure 2 and Video 1). The patient was discharged home the following day on aspirin 81 mg and Plavix 75 mg. A follow-up CT angiography at 45 days demonstrated a stable LAmbre device without any thrombus or leaks (Figure 3).
The LAmbre device offers an alternative for patients who may not qualify for conventional LAA occlusion devices. Future studies are needed to establish the safety and efficacy of the device.
Affiliations and Disclosures
From the 1Center for Structural Heart Disease, Division of Cardiology, Henry Ford Health System, Detroit, Michigan.
Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Wang reports consultant income from Edwards LifeSciences and Boston Scientific; research grant support to his institution from Boston Scientific; patent on LAA device modeling software (assigned to employer, Henry Ford Health System). Dr Frisoli is a proctor for Edwards LifeSciences and Boston Scientific. Dr Eng is a proctor for Edwards LifeSciences. Dr O’Neill reports consultant income and research support from Edwards Lifesciences. The remaining authors report no conflicts of interest regarding the content herein.
Manuscript accepted June 4, 2021.
The authors report patient consent for the images used herein.
Address for correspondence: Mohammed Qintar, MD, MSc, Henry Ford Hospital, Center for Structural Heart Disease, 2799 West Grand Blvd, Clara Ford Pavilion, 4th Floor, Detroit, MI, 48202. Email: mohammedqintar@hotmail.com
References
1. Alkhouli M, Holmes DR. Remaining challenges with transcatheter left atrial appendage closure. Mayo Clin Proc. 2020;95:2244-2248.
2. Ali M, Rigopoulos AG, Mammadov M, et al. Systematic review on left atrial appendage closure with the LAmbre device in patients with non-valvular atrial fibrillation. BMC Cardiovasc Disord. 2020;20:78.
