The Publio Cordón Memorial Hospital has successfully carried out its first percutaneous closure of the left atrial appendage
The procedure, carried out by Dr Felipe Hernández, head of the Haemodynamics and Interventional Cardiology Unit, offers a minimally invasive alternative to reduce the risk of stroke in certain patients with atrial fibrillation.
The Publio Cordón Memorial Hospital has successfully carried out its first percutaneous closure of the left atrial appendage, a highly specialised procedure performed by Dr Felipe Hernández, head of the centre’s Haemodynamics and Interventional Cardiology Unit.
The procedure took place in the hospital’s hybrid operating theatre, a facility equipped with advanced imaging technology that combines the capabilities of an interventional suite with the conditions and resources typical of an operating theatre. This environment enables complex cardiovascular procedures to be carried out with a high level of precision and control throughout all stages of the procedure.
The completion of this first closure expands the treatment options available at the Publio Cordón Memorial Hospital for certain patients with atrial fibrillation who are at risk of stroke, particularly when long-term anticoagulant therapy has limitations or carries a high risk of bleeding.
“Atrial fibrillation can promote the formation of clots inside the heart. In a very significant proportion of cases, these clots originate in the left atrial appendage and can travel to the brain, causing a stroke,” explains Dr Felipe Hernández.
The left atrial appendage is a small cavity located in the left atrium of the heart. When atrial fibrillation is present, the abnormal heart rhythm can cause blood to pool in this structure and, as a result, lead to the formation of blood clots.
Although anticoagulation is the main strategy for reducing this risk, some patients have a history of bleeding, contraindications, intolerance to the treatment or other clinical circumstances that make it difficult to maintain anticoagulation over the long term.
In such cases, and always following an individualised assessment, percutaneous closure of the left atrial appendage may offer an alternative to reduce the risk of a thrombus reaching the cerebral circulation.
A minimally invasive, image-guided procedure
Atrial appendage closure is performed without the need for open-heart surgery. Through a small puncture in the femoral vein, usually in the groin area, a catheter system is inserted and guided to the heart.
Once the left atrium is reached, the specialist implants a device designed to seal the atrial appendage opening and exclude it from the blood circulation. This prevents any clots that may form inside it from entering the bloodstream.
During the procedure, imaging systems are used to visualise the cardiac anatomy, guide the advancement of the catheters and check the position and stability of the device before its final deployment.
“The success of the procedure depends on rigorous planning and a high degree of technical precision. Having access to advanced real-time imaging allows us to study the anatomy of the atrial appendage, select the appropriate device and verify that it has been implanted correctly,” says Dr Hernández.
The hybrid operating theatre plays a particularly important role in this type of procedure, as it brings together, within a single space, high-precision technology and all the resources needed to respond to the various requirements that may arise during the procedure.
“Working in an environment of this kind provides a high level of control and safety. The technology allows us to make decisions during the procedure based on highly accurate information, but this must always be accompanied by experience, clinical judgement and appropriate patient selection,” adds the specialist.
An alternative for carefully selected patients
Percutaneous closure of the left atrial appendage is not a general substitute for anticoagulant therapy, nor is it indicated for everyone with atrial fibrillation.
The decision requires an assessment of the risk of stroke, history of bleeding, cardiac anatomy and the overall clinical condition of each patient. It also demands coordinated planning amongst the specialists involved and subsequent follow-up to verify the correct integration of the device.
“The key lies in tailoring the indication to the individual. This technique allows us to offer a solution to patients for whom we must balance a significant risk of stroke against the difficulties or complications associated with anticoagulant therapy,” says the head of the Haemodynamics and Interventional Cardiology Unit.
As it is a percutaneous procedure, it does not require opening the chest and reduces the invasiveness of the surgery. When the outcome is favourable, it can lead to a faster recovery and a shorter hospital stay.
The successful completion of this first percutaneous closure of the left atrial appendage marks the introduction of a new procedure into the cardiovascular services at the Publio Cordón Memorial Hospital and provides patients with access to the expertise of a specialised team, state-of-the-art technology and a hybrid operating theatre equipped for highly complex procedures.
“Having these resources at our disposal enables us to perform advanced procedures with precision and offer new alternatives to patients with particularly delicate clinical conditions. The aim is not to incorporate technology for its own sake, but to use it where it can provide a real benefit and improve the safety of treatment,” concludes Dr Felipe Hernández.
