AF’de Felç Riskini Azaltan LAA Kapatma Tedavisi

What is left atrial appendage closure?

The two upper chambers of the heart are called atria, and the two lower chambers are called ventricles. Both the right and left atria have pouch-like protrusions. The one on the left side is called the “left atrial appendage,” which means “the protrusion of the left atrium. In English, it is left atrial appendage (LAA). A clot can form in the LAA as a result of a common rhythm disorder called atrial fibrillation (AF). This clot may one day dislodge and, as the heart pumps blood, travel through the blood vessels to the brain, blocking blood flow and causing a stroke. Left atrial appendage closure is the non-surgical closure of this pouch to prevent clot formation and protect the patient from stroke.

What is LAA shutdown?

LAA closure is the short name for the left atrial appendage closure procedure.

Who is eligible for the LAA termination process?

This procedure is performed for patients who have a rhythm disorder called AF and need to use blood-thinning medications to prevent clot formation, but for whom using these medications is risky for some reason. For example, patients who have experienced a brain hemorrhage or stomach bleeding due to these medications while using blood thinners are among the suitable candidate groups for this treatment. Restarting blood thinners for these patients carries the risk of re-bleeding, while not starting them carries the risk of clot formation within the heart. This is exactly where the LAA closure procedure comes into play. The rationale of the procedure is based on both preventing clot formation and eliminating the lifelong need for blood-thinning medication. Sometimes, a clot may still form despite the patient taking the appropriate dose of blood thinners. In such cases, LAA closure can also be performed. In certain professions, LAA closure may be considered in the presence of AF. Examples include professions with a high probability of bleeding due to physical trauma, such as firefighting, or professions that pose a vital risk to others in the event of bleeding, however rare, such as piloting. Elderly people who frequently fall and experience physical trauma, or patients who cannot use blood-thinning medications due to reasons such as allergies, side effects, or forgetfulness, are also suitable groups for the LAA closure procedure.

Is the LAA closure procedure suitable for all patients with atrial fibrillation?

No. LAA closure is not appropriate for patients with atrial fibrillation (AF) who have a mechanical heart valve or rheumatic heart valve stenosis.

Is the LAA closure procedure an experimental treatment method?

This procedure is not an experimental treatment method. It has received FDA and CE approval. To date, it has been performed on more than 250,000 patients worldwide.

What is the likelihood of the transaction being successful?

The overall success rate is over 95%.

What are the risks of the LAA closure procedure?

As with any invasive procedure, there are certain risks associated with LAA closure. Serious complications, such as device dislodgement, blood clot formation on the device, and death, occur in a total of 2 out of every 100 people. However, this probability is much lower than the risk of stroke that could occur if the procedure is not performed.

You may be justified in feeling concerned about these risks; but remember: these complications are rare. What matters is whether this procedure is truly necessary. If the decision has been made in accordance with current scientific data and guidelines, avoiding this procedure would mean exposing yourself to a threefold higher risk of stroke (See References).

What tests are performed before the procedure?

Blood tests: To check for other conditions such as anemia, kidney failure, and infection.
ECG and rhythm Holter: To confirm the presence of the heart rhythm disorder called AF.
CT (Computed tomography): To determine if the heart’s pouch (LAA) is anatomically suitable for closure and to create the procedural plan.
TEE (Transesophageal Echo): To understand if the sac is anatomically suitable for closure, to prove that there is no clot inside the sac, and to create the procedural plan.

Isn’t surgically closing the LAA a more reliable method?

No. On the contrary, due to technical reasons, the likelihood of successfully closing the LAA through surgery is lower. Furthermore, undergoing surgery solely for this purpose means taking on additional risks. However, if the patient is scheduled for heart surgery for another reason, it is recommended that the LAA be closed at the same time during the procedure.

How long does the LAA deactivation process take?

Typically 1.5 hours. However, in cases involving complex LAA anatomy, this duration may be longer.

Is the procedure performed by stopping the heart, as is done in heart surgery?

No, there is no need to stop the heart.

Is there any pain during the LAA closure procedure?

No. The procedure is performed either under sedation or under general anesthesia. The difference is this: Under general anesthesia, a tube is inserted into the patient’s airway, and the patient receives air from a ventilator; under sedation, no breathing tube is inserted, the patient is not connected to a ventilator, and the patient is simply put to sleep while breathing on their own. In both techniques, medications are administered to prevent the patient from feeling pain during the procedure. Performing the procedure under general anesthesia (with intubation) is more comfortable for the patient.

When will I be discharged after the procedure?

Most patients stay in the hospital for one day and are then discharged.

Which is the best LAA shut-off device?

As is the case worldwide, devices from brands such as Amulet, LAmbre, or Watchman FLX are frequently used in our country as well. All three are high-quality, and none has a significant advantage over the others. The choice depends on the physician’s experience with a particular device and the anatomy of the left atrial appendage (LAA).

LAA Closure

Does the LAA device come loose?

No. Although cases in which the implant has apparently shifted from its original position have been reported in the literature, this is a rare occurrence.

Can you feel the device in your body?

No.

Will the device remain in the body for life?

Yes. There is no question of removing the device.

Will I need to take blood-thinning medication after the procedure?

Yes. Typically, two blood thinners are used simultaneously for the first 2–3 months. After that, one of the two blood thinners is discontinued, and the other is used alone until the 6th month. After the 6th month, blood thinners are generally no longer used.

Let’s briefly touch on a detail that can be confusing: Although non-medical professionals often refer to them all as “blood thinners,” the blood thinners used for a heart rhythm disorder called AF are different from those used after an LAA closure procedure. Additionally, the medications used after the procedure are not taken for life but are generally used for only 6 months. Therefore, the patient assumes the risk of bleeding associated with anticoagulant medications not for life, but for 6 months. Moreover, this risk is lower because milder anticoagulant medications are used. Since anticoagulant medications are generally not used after the 6th month, the risk of bleeding associated with the medication is also eliminated.

What should you keep in mind after LAA is closed?

Competitive or heavy sports should be avoided for the first month after LAA closure.
It may take up to 6 months for the device to be covered with tissue after LAA closure. During this process, microorganisms entering the bloodstream can directly contaminate the device through the blood and lead to a serious infection called infective endocarditis. Therefore, during the first 6 months, it is necessary to take antibiotics before procedures involving bleeding, such as tooth extraction or surgery on another organ. After 6 months, such precaution is not needed. However, rarely, a permanent blood leak from the edge of the device may persist; in this case, taking antibiotics before procedures involving bleeding is always recommended.
Due to the metallic structure of these devices, which are made of nickel-titanium alloy, it is often thought that they will be affected by the magnetic field of an MRI. However, the magnetic susceptibility of these devices is weak; therefore, there is no harm in undergoing an MRI, including 3 Tesla.

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