Page 557 - Read Online

Maurina et al. Mini-invasive Surg 2021;5:53 https://dx.doi.org/10.20517/2574-1225.2021.88 Page 5 of 13

Figure 1. (A) The WATCHMAN and WATCHMAN FLX devices consist of a self-expandable nitinol cage covered by a membrane of
polyethylene terephthalate (PTFE). (B) Heart tissue grows over the PTFE membrane guaranteeing device endothelialization and left
atrial appendage (LAA) sealing. (C) The interatrial septum is crossed, and the device is released in the LAA.

Figure 2. (A) First generation Amplatzer Cardiac Plug; and (B) second generation Amulet showing a deeper distal lobe with a larger
proximal closure disc.

main advantage of these devices is that they possibly allow a complete closure of tortuous LAAs and of
multilobulated appendages . Although both devices received the CE mark in 2016, they are still not widely
[22]
used in clinical practice .
[23]
The ligation principle
LAA ligation simulates surgical closure and consists of snaring and ligating the body of the LAA with a
double epicardial and endocardial approach. This principle is exploited by the LARIAT™ (SentreHEART,
Pleasanton, CA; CE approved in 2015), which is a suture delivery device that is released around the LAA