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Table 2 Potential prevention strategies for procedural complications of LARIAT LAAO (Price 2014; Keating et al. 2014)

From: A review of the LARIAT device: insights from the cumulative clinical experience

Complication

Cause

Preventative strategy

Pericardial effusion

Initial TSP

Guide wire or catheter trauma to LAA after TSP

Manipulation of delivery system in pericardium

Pericardial access

TEE guidance

Avoidance of severe IAS tenting

Advancement of trans-septal sheath dilator into LAA under fluoroscopy over 0.32″ wire with distal curve on coronary wire

TEE surveillance for RV compression with sheath advancement to avoid RV abrasion

Micro-puncture access needle

Placement of a ‘bail out’ wire in the pericardium for quick pericardial drain placement

LAA laceration or perforation

LARIAT advancement and deployment

Cognizance of endocardial and epicardial wire forces on LAA

Minimization of LARIAT delivery system prolapse onto LA

Careful suture tightening

Procedural stroke

LAA thrombus

Insufficient AC

Air embolus

Careful baseline TEE

Close AC monitoring

Careful flushing of trans-septal sheath

Vascular complications

Hematoma, arterio-venous fistula, pseudoaneurysm, bleeding, hematoma

Careful technique with ultrasound guidance as needed

  1. TSP trans-septal puncture, IAS inter-atrial septum, RV right ventricle