Transcatheter Left Atrial Appendage Exclusion: Preclinical and Early Clinical Results With the Laminar Device

• Published in: JACC. Cardiovascular interventions Vol. 16; no. 11; p. 1347
• Main Authors: Wong, Gordon X, Kar, Saibal, Smith, Thomas W, Spangler, Taylor, Bolling, Steven F, Rogers, Jason H
• Format: Journal Article
• Language: English
• Published: United States 12.06.2023
• Subjects: Animals; Atrial Appendage - diagnostic imaging; Atrial Fibrillation - diagnostic imaging; Atrial Fibrillation - therapy; Cardiac Catheterization - adverse effects; Cardiac Catheterization - methods; Dogs; Echocardiography, Transesophageal; Humans; Stroke - etiology; Stroke - prevention & control; Thrombosis; Treatment Outcome; atrial fibrillation; left atrial appendage occlusion; peridevice leak; left atrial appendage closure; device-related thrombus
• ISSN: 1876-7605; 1876-7605
• DOI: 10.1016/j.jcin.2023.04.028

The Laminar device rotates and closes the left atrial appendage (LAA) using an integrated ball and lock that excludes and eliminates the LAA pouch. There is a low device surface area, minimizing the risk of peridevice leak (PDL) and device-related thrombus (DRT) formation. This study evaluates the safety and efficacy of the Laminar LAA exclusion device in healthy animals and human subjects with nonvalvular atrial fibrillation at risk of ischemic stroke and systemic thromboembolism. The preclinical study implanted the Laminar device into canine subjects that underwent transesophageal echocardiography (TEE) and fluoroscopic evaluation, followed by necropsy and histological assessment at 45 and 150-days post-implant. The early clinical study implanted the device in human subjects, followed to 12 months postimplantation. Procedural success was defined as device implantation in the intended location without residual LAA leak >5 mm as seen by TEE. Safety endpoints included freedom from stroke, systemic embolism, pericardial effusion, or tamponade, life-threatening/major bleeding, or death. The Laminar device was successfully implanted in 10 canines. In all animals at 45 days and 150 days, no PDL or DRT was found, and histological examination showed fully closed LAAs covered with neo-endocardium. The device was successfully implanted in 15 human subjects with no safety events out to 12 months postimplantation. All subjects had successful protocol-defined LAA closure without DRT at 45 days by TEE and computed tomography, which remained stable through 12 months' follow-up. The preclinical and early clinical results demonstrate a promising safety and efficacy profile for the Laminar LAA exclusion device.