Discussion:
The detachment of occluder is one of the most serious complications of
LAAC surgery, often
occurring during the perioperative period. The main reasons for the
detachment of the occlude
include: (1) The size of the occluder is too small relative to the
diameter of the auricle, (2) The
occluder is placed too far out and not firmly fixed, (3) The pre
installation of the occluder is not firm,
or the screw at the connection between the push rod and the occluder
occurs after the occluder is fully
recovered. When the intervention method for removing the occluder is
expected to be difficult or
carries significant risks, it is recommended to perform cardiac surgery
for removal.
In early LAAO surgical experience, The incidence of complications such
as pericardial tamponade,
occluder displacement, and thromboembolism is relatively high. In the
past decade, improved operational experience, meticulous techniques, and
improved equipment iteration have greatly
reduced the incidence of major complications(6). Although the current
indications of LAAO mainly
focus on non valvular atrial fibrillation patients and contraindications
for oral anticoagulation, it is
almost certain that the future will expand the indications,
applicability, and scope of use of these
devices(7).Moreover, different designs of the left atrial appendage
occluder may affect prognosis
(such as detachment or embolism). The advantage of devices without an
external disc is that it has
less interference with surrounding structures and a smaller surface that
interacts with blood (8). At
present, research has discussed the use of virtual reality (VR)derived
from cardiac computed
angiography data to predict the size of LAAO devices. VR visualization
of the left atrial appendage
opening from different perspectives can better understand its
funnel-shaped structure. The VR measurement of the maximum opening
diameter has the strongest correlation with the diameter of
the insertion device. Therefore, VR may provide new imaging
possibilities for evaluating complex
preoperative structures such as the left atrial appendage. To prepare
suitable occluder before LAAO
surgery and reduce the occurrence of occluder detachment(9).