Advancements in Transcatheter LAA Closure Techniques | RIO 2024

This session was chaired by Devi Nair (Jonesboro, US) and featured case operator Ole De Backer (Copenhagen University Hospital, Copenhagen, DK), with expert panellists Dhiraj Gupta (Liverpool, UK) and Horst Sievert (Frankfurt, DE). Dr De Backer presented a complex left atrial appendage (LAA) closure case using the OMEGA device in a 76-year-old patient with a history of atrial fibrillation and contraindications for long-term anticoagulation. He explained his approach using CT imaging for pre-procedural planning, highlighting the benefits of precise sizing and optimal implantation views. The case involved a challenging acutely angulated LAA anatomy, requiring a posterior transseptal puncture and intraprocedural guidance using intracardiac echocardiography (ICE). The team discussed sizing strategies, comparing the OMEGA device with others like WATCHMAN FLX and the importance of coaxial alignment for successful implantation. Dr De Backer demonstrated the OMEGA device’s deployment, emphasising its flexibility, double-layered cup and high occlusion rates. He detailed the implantation process, including sheath manipulation, device anchoring with five rows of hooks and optimal depth positioning to ensure effective occlusion. The panel discussed considerations for patient selection, device sizing and strategies for handling challenging anatomies. Dr De Backer noted that the OMEGA device provides strong procedural reliability, with a low need for device resizing and excellent post-procedural occlusion rates. The session concluded with a discussion on potential limitations of the device and delivery system, followed by a preview of the next case featuring a conformable LAA closure device.