Percutaneous transcatheter closure of the left atrial appendage with implant, including fluoroscopy, transseptal puncture, catheter placement(s), left atrial angiography, left atrial appendage angiography, radiological supervision and interpretation
CPT4 code
Name of the Procedure:
Percutaneous Transcatheter Closure of the Left Atrial Appendage (LAA) with Implant (LAAO)
Summary
The percutaneous transcatheter closure of the left atrial appendage (LAA) is a minimally invasive procedure that involves inserting a device to seal off the LAA, a small sac in the upper-left chamber of the heart. This procedure is performed using imaging guidance to help prevent complications associated with atrial fibrillation, such as stroke.
Purpose
This procedure addresses the risk of stroke in patients with atrial fibrillation (AFib) by preventing blood clots from forming in the LAA and entering the bloodstream. The goal is to reduce the need for long-term anticoagulant (blood-thinning) medications and their associated risks.
Indications
- Patients with non-valvular atrial fibrillation who are at high risk of stroke.
- Individuals who cannot take anticoagulant medications due to bleeding risks or other contraindications.
- Patients with a history of stroke or transient ischemic attack (TIA) despite anticoagulant therapy.
Preparation
- Fasting for a specified period (usually 6-8 hours) before the procedure.
- Adjusting or temporarily stopping certain medications, especially blood thinners.
- Undergoing diagnostic tests such as blood work, an electrocardiogram (ECG), and imaging studies like a transesophageal echocardiogram (TEE) to assess the LAA.
Procedure Description
- Anesthesia and Sedation: The procedure is typically performed under general anesthesia or conscious sedation.
- Access: A catheter is inserted through a vein in the groin and guided to the heart.
- Transseptal Puncture: A puncture is made in the septum (the wall between the right and left atria) to access the left atrium.
- Imaging: Fluoroscopy and transesophageal echocardiography (TEE) are used to visualize the heart and guide the catheter.
- Catheter Placement: The catheter is positioned in the left atrial appendage.
- Device Deployment: An occlusion device is deployed to seal off the LAA.
- Confirmation: Left atrial and LAA angiographies confirm proper placement and sealing of the appendage.
- Completion: The catheter is removed, and the puncture site is sealed.
Duration
The procedure typically takes about 1 to 2 hours.
Setting
- Performed in a hospital cath lab or specialized cardiac surgical center.
Personnel
- Interventional cardiologist
- Cardiac anesthesiologist or anesthesia team
- Cardiac nurses
- Radiologic technologists
Risks and Complications
- Bleeding or hematoma at the puncture site
- Infection
- Perforation of the heart or blood vessels
- Blood clots or stroke
- Device-related issues (e.g., misplacement, dislodgement)
Benefits
- Effective reduction in stroke risk for patients with atrial fibrillation.
- Potential elimination or reduction in the use of anticoagulant medication.
- Improved quality of life with fewer stroke-related complications.
Recovery
- Monitoring in a recovery area or intensive care unit for several hours post-procedure.
- Bed rest and activity restrictions for a short period.
- Follow-up appointments to monitor the implant and overall heart health.
Alternatives
- Long-term anticoagulant medication therapy
- Surgical LAA removal or occlusion
- Continued medical management of atrial fibrillation without LAA closure
Patient Experience
Patients may experience mild discomfort at the catheter insertion site and some soreness. Conscious sedation or general anesthesia will minimize pain during the procedure. Pain and discomfort can be managed with medication, and most patients can resume normal activities within a few days to a week.