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2025 AF Symposium
Cases Demonstrating New LAA Closure Device: Two Presentations
Dr. Vivek Reddy
In his first of two presentations, a prerecorded video, Dr. Vivek Reddy, Director of Electrophysiology for the Mount Sinai Health System, demonstrated a new device to close off the Left Atrial Appendage (LAA), the Append Transcatheter System (Append Medical).
The video was produced in the Czech Republic by Dr. Petr Neuzil, director of cardiac arrhythmia service at Homolka Hospital in Prague. The case presentation was titled “Elimination of the Left Atrial Appendage by Invagination and Ligation with a Novel Transcatheter System.”
Append Transcatheter System LAA Closure Device—How It Works
Illustration: How the Transcatheter System LAA Closure Device
In this procedure a small cup is advanced into the tip of the left atrial appendage (LAA), then a vacuum is applied to suck the LAA into the larger cup (invagination).
Then a suture is applied to tie the appendage from the outside which basically strangles the LAA. The LAA is essentially “telescoped” into the left atrium.
A suture basically strangles the LAA.
“Invagination” is the process of turning the LAA inside out and folding it back on itself to form a pouch or cavity.
At this point the larger cup is withdrawn, and the tied-off suture is cut.
Eventually the size of the remaining LAA tissue decreases and atrophies (necrosis, degeneration). Dr. Reddy talked about a 95% decrease in the size of the LAA.
The left atrial appendage (LAA) is a finger-like extension of the heart’s left atrium; It is the source of many blood clots causing strokes in patients with atrial fibrillation. Closure of the LAA aims to reduce stroke risk and often eliminates the need to take anticoagulants.
Video Demo of Two Different Cases
The video demonstration showed two different cases. The first was a 59-year-old female with a relatively small LAA. She had a bleeding problem on the anticoagulant Apixaban (brand name Eliquis), a retinal hemorrhage, and needed to have her LAA closed off or removed.
The second case was a man with a large and long LAA. [I didn’t notice any major difference in the technique or process with the two different sizes of LAA.]
As we watched the video, Dr. Reddy showed us how the stabilizer stand table-top device delivers a small suture to the telescoped LAA by simply rotating a knob.
[The stabilizer stand device to me looked similar to the Laminar device (Biosense Webster) which I described last year.]
It did not rotate or twist the LAA tissue like the Laminar device. This may be an advantage in the case of older patients whose LAA may be thinner or more fragile and more apt to tear. But research to-date has not shown this to be a problem.
Dr. Reddy said there were no leaks using this Append Medical vacuum system. He also said this system was easy to use.
Following the procedure, patients were put on an anticoagulant for 45 days.
Dr. Reddy’s Second Talk—Feasibility and Safety
Dr. Reddy’s second presentation, part of the Late Breaking Clinical Science Session 1, was on the clinical results of the Append system “Left Atrial Appendage Elimination by Vacuum-based Invagination and Ligation: A First-in-Human Clinical Experience.”
He described two European studies looking at feasibility and safety. These studies were preliminary and small with only 15 patients.
In these studies, there was no Device Related Thrombus (DRT) or Peridevice Leak (PDL). It took an average of 24 minutes to install the device.
The LAA tissue atrophied after 1 month with a 50% decrease in size. After 90 days the LAA was atrophied. All leaks were eliminated.
An added benefit was the elimination of all electrical activity in the atrophied LAA.
There were some preliminary distance and logistics restrictions on the use of the Append system:
• the distance from the LA [Left Atrial] Ostium to the Mitral Valve can’t be less than 8mm
• the distance from the Fossa Ovalis to the Appendage Ostium can’t be less than 40mm.
Editor’s Comments
Editor’s CommentsNew LAA Occlusion Device: The Append Transcatheter System interests me because it closes the LAA without using a metal implant like some other occlusion devices.
It’s encouraging news for A-Fib patients that there is now an additional LAA closure device which seems to work very well—the Append Transcatheter System (Append Medical).
Though more follow-up research needs to be done, it may prove as or even more effective than other occlusion devices such as the Watchman (Boston Scientific) , Laminar (Biosense Webster), or Amulet (Abbott).
What This Means to A-Fib Patients
Left Atrium Appendage (LAA) closure devices are no longer considered experimental or not proven.
Caution: Taking an anticoagulant long-term can cause bleeding and other problems. LAA closure devices are more often than not a welcome alternative to a lifetime on anticoagulants.
If someone wants to leave you on anticoagulants for the rest of your life, get a second opinion.
· Append Transcatheter System (Append Medical)
· Laminar (Biosense Webster)
· Watchman (Boston Scientific)
· Amulet (Abbott)
Note: Current Left Atrial Appendage occlusion devices: 
