LARIAT or AtriClip: Complications Profile and Comparison in Patients with Atrial Fibrillations Based on Manufacturer and User Facility Device Experience Database

Background and Objectives: Left atrial appendage closure is an alternative treatment to reduce thromboembolism in patients with atrial fibrillation in whom oral anticoagulation (OAC) is contraindicated. The aim of this study was to evaluate the complications profiles of the LARIAT and AtriClip devices and perform a comparison between them based on the MAUDE (Manufacturer and User Facility Device Experience) database. Materials and Methods: The Manufacturer and User Facility Device Experience database was searched on 15 January 2023. For AtriClip, only reports regarding isolated procedures or procedures associated with minimally invasive ablation were included. Adverse effects and causes of death were defined based on the literature on the topic and the causes described in the reports. In total, 63 patients were included in the LARIAT group and 53 patients were included in the AtriClip group. Results: With the LARIAT device, the most common complication without device problems was pericardial effusion (n = 18, 52.9%), whereas this complication was not observed with AtriClip (p < 0.001). Postoperative bleeding was a second complication that occurred significantly more often in the LARIAT group-in 15 (44.1%) cases versus 1 (2.7%) case with AtriClip (p < 0.001). In addition, significant differences were found in the prevalence of stroke (LARIAT n = 0 vs. AtriClip n = 7, 18.9%, p = 0.012) and thrombus (LARIAT n = 2, 5.9% vs. n = 11, 29.7%, p = 0.013). Conclusions: Each type of left atrial appendage closure procedure is associated with device-specific requirements and complications that, if known, can be avoided.

Morphology and Anatomical Classification of Pericardial Cavities: Oblique and Transverse Sinuses

The pericardial sinuses are an important anatomical feature of the pericardial cavity, however, their clinical anatomy has not been thoroughly studied. In this study, we aim to provide the first classification of the oblique and transverse sinuses. We analyzed 121 computer tomography scans (46.3% female, age of 66 ± 12 years) of the pericardial cavity. The oblique sinuses were classified into four types: 1 (shallow with narrow entrance), 2 (shallow with wide entrance), 3 (deep with narrow entrance), and 4 (deep with wide entrance). The transverse sinuses were classified into four types: Concave, Wine-type, Straight, and Convex. The most common oblique sinus type was Type 1. The median oblique sinus volume was 8.4 (5.3) mL, the median entrance length was 33.0 (13.2) mm, and the depth was 38.2 (11.8) mm. The most common transverse sinus type was Concave. The median transverse sinus volume was 14.8 (6.5) mL, and the median length was 52.8 (17.7) mm. Our study provides an anatomical classification of the pericardial sinuses. The individual variability of the sinuses' morphology highlights the importance of understanding the clinical topography of the sinuses, particularly for minimally invasive thoracic ablation procedures.

The thyrocervical trunk: an analysis of its morphology and variations

The number of studies on the variations of the branching of the TT is scarce, and those works that treat about the different types of the said trunk are oftentimes inconsistent. Therefore, the authors of the present study would like to propose a set of five types of TT, which were created based on observations of 41 computed tomography angiographies (82 TTs). To establish the anatomical variations, their prevalence, and morphometrical data regarding the TT and its branches, a retrospective study was performed. The results of 55 consecutive patients who underwent neck and thoracic computed tomography angiography (CTA) were analyzed. The analysis was performed on a total of 82 TTs of 41 patients, aged 15 to 82 years (mean age: 46 years; SD: 18.4), of which 16 (39.0%) were females, and 25 (61.0%) were males. Initially, 11 types of variations were evaluated, of which types 1-4 constituted 89.0%. Furthermore, a new method of classification of the anatomical variations of the TTs has been established. In this study, the variety of the branching and morphology of the TT was presented, proposing its novel classification based on the five most commonly prevalent types. Types 1 and 2 were the most common, with a prevalence of 26.8% each. This work also provides physicians with crucial data about the morphology of the TT and its branches, which can surely be of use when performing endovascular or reconstructive procedures in the cervical region.

Air spaces of the temporal bone: a morphometric analysis with clinical implications

BACKGROUND

The main objective of the present study was to analyse the morphological variations of the air spaces of the temporal bone, that is, the pneumatized and air-filled spaces of the temporal bone cavities.

MATERIALS AND METHODS

A total of 99 sides were analysed. Temporal bone pneumatic spaces (TBPS) were defined as the free spaces inside the cavities of the temporal bone filled with air, excluding the volume of the structures present in the investigated region. Total volumes of TBPS were calculated as the sum of total volumes of mastoid air cells (MAC), tympanic cavity (TC), and external auditory canal (EAC). Analyses were performed considering the general population and the female and male subgroups.

RESULTS

The overall results obtained on Polish population were set as follows: the median total volume of TBPS was demonstrated at 7882.58 mm3 (lower quartile [LQ]: 6200.56 mm3; higher quartile [HQ]: 10393.16 mm3). The median volume of MAC was set at 5813.05 mm3 (LQ: 4224.94 mm3; HQ: 8181.81 mm3). The median of the total volume of the EAC was demonstrated at 1294.36 mm3 (LQ: 1099.68 mm3; HQ: 1627.84 mm3).

CONCLUSIONS

In the present study, the morphometric properties of the temporal bone cavities were analysed. The results showed that the total volume of the MAC was, on average, lower in women than in men. This should be taken into account when performing procedures on the mastoid, such as mastoidectomies. It is hoped that the results of this study can help reduce potential surgical complications associated with otological procedures.

Left Internal Mammary Artery Operative Topography for MIDCAB and TECAB Procedures

OBJECTIVE

The left internal mammary artery (LIMA) is a common arterial graft in minimally invasive coronary surgery (MICS), such as minimally invasive coronary artery bypass grafting (MIDCAB) or totally endoscopic coronary artery bypass (TECAB). The aim of this study was to perform an analysis of the LIMA operative topography during MICS.

METHODS

A total of 104 computed tomography angiographies were analyzed retrospectively using 3-dimensional reconstruction and visualization software. Measurements were developed in relation to the anatomical midpoint of the sternal body (SBMP). Parameters were evaluated as lengths, distances, diagonals, or categorical descriptions.

RESULTS

A total of 208 internal mammary arteries of each side were analyzed with the following results: (1) LIMA width = 2.7 mm, (2) SBMP-LIMA bifurcation length = 6.2 cm, (3) SBMP-LIMA distance = 3.2 ± 0.5 cm, (4) xiphoid midpoint-LIMA distance = 3.5 ± 0.7 cm, (5) sternal line-LIMA distance = 1.7 ± 0.3 cm, (6) xiphoid end projection-LIMA bifurcation length = 2.2 ± 1.0 cm, (7) midsternal line-LIMA bifurcation distance = 3.3 ± 0.8 cm, (8) xiphoid end-LIMA bifurcation diagonal = 4.1 ± 0.9 cm, (9) LIMA-left coronary artery distance = 7.0 ± 1.4 cm at the proximal and 7.1 ± 1.3 cm at the distal segment, and (10) LIMA-left anterior descending artery distance = 5.5 ± 1.1 cm at proximal, 4.3 cm at middle, and 4.2 ± 1.5 cm at distal segment. The extent of LIMA bifurcation ranged from the level of 5 (1%) to 7 (6%) rib cartilages.

CONCLUSIONS

Based on the detailed surgical anatomy of LIMA, it was concluded that the fourth intercostal space should be considered as an appropriate approach for MIDCAB or TECAB in the studied region.

Left Atrial Appendage Morphology and Course of the Circumflex Artery: Anatomical Implications for Left Atrial Appendage Occlusion Procedures

OBJECTIVE

The aim of this study was to evaluate the anatomic topography of the circumflex artery (Cx) and left atrial appendage (LAA) and to determine the safety zones for epicardial LAA closure and LAA occlusion procedures.

METHODS

The left coronary artery was segmented and visualized from 116 computed tomography angiography scans. Four points were located on the Cx portion periappendicularly, starting from the entry point. The landing zone plane was defined as parallel to the LAA orifice at the level of the beginning of the periappendicular course of the Cx, and the plane of the neck bend was located at the end of the LAA neck. A distance smaller than 2 mm was considered a dangerous distance.

RESULTS

The distance between the Cx and the LAA landing zone was 4.3 ± 2 mm. The distance between the Cx and the LAA neck bend was 5.1 ± 2.2 mm. The distance between the Cx and the LAA bottom surface was 5.8 ± 2.9 mm. In 38.8% of patients, at least 1 distance between Cx and LAA was smaller than 2 mm in at least 1 dimension. These distances occurred in 30.2% of the LAA landing zone dimensions, 19.8% of LAA neck bend dimensions, and 11.2% of the LAA bottom surface distances.

CONCLUSIONS

The study showed that most dangerous distances (30.2%) occurred in the LAA landing zone dimension. The data showed that landing zones more distal from the orifice of the LAA are safer in terms of Cx damage. Therefore, LAA closure should always be performed with caution, to avoid iatrogenic complications.