Trevor A. McCaw

Novel percutaneous left atrial appendage closure

The primary disease target for our innovation is thromboembolic stroke from AF. This disease is addressed by removing the LAA from the systemic circulation using a novel percutaneous epicardial transcatheter based solution. In addition to avoiding the morbidity of open heart surgery, this solution does not necessitate entering a cardiac chamber. Thus, no device or hardware is exposed to the systemic circulation obviating the need for either procedural or even temporary postprocedural anticoagulation. Specific unique features of the innovation include a hollow suture, closure of the suture via a percutaneous approach, and the use of electrical signal-based navigation. Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice, and it poses a growing health hazard [1]. It affects 2.2 million Americans and is expected to afflict up to 16 million by the year 2050 [2]. Atrial fibrillation has been associated with an increased risk of thromboembolism [3]. Due to its complex anatomy and diminished blood flow during AF, the left atrial appendage (LAA) has been a common site of left atrial thrombi, accounting for 98% of such thrombi in transesophageal echocardiography (TEE)-based studies [4,5]. Currently, oral anticoagulation is the best established prophylactic therapy for stroke prevention in AF [6,7]. Unfortunately, due to numerous drug and dietary interactions, the narrow therapeutic window and need for frequent blood tests to ensure safe anticoagulation, as well as the inherent risk of major bleeding, warfarin is frequently underutilized in individuals at risk of thromboembolism [8,9]. Dabigatran, apixaban, and rivaroxaban are new oral agents that have been shown to be non-inferior or superior to warfarin in large