John Wolter, an 84 year old from Lincoln, Nebraska, had no doubts about getting the new LARIAT procedure. “I wasn’t concerned at all because I had talked to Dr. Gallagher about what my heart deficiencies were. Then I met Dr. Nagaraj and when I told him my symptoms…they approved me for the procedure, saying that I was the perfect candidate.”
LARIAT was designed as a method of closing the left atrial appendage (LAA) without the need for major surgery. The procedure is performed in the cardiac catheterization lab under X-ray guidance and requires no incision. The LARIAT was approved by the FDA for use in 2009 and is also approved in Europe. Only a few hospitals in the nation perform this particular form of out-patient surgery, with the NebraskaHeartHospital being one of them.
Wolter was particularly interested in the LARIAT procedure because his anti-coagulant (blood thinning) drugs made him feel light-headed and unsteady, and this new procedure could wean him off of these drugs. In fact, many candidates for the LARIAT procedure can’t be on anti-coagulants for an extended period of time because of bleeding problems or the risk of falling which is why LARIAT is such a great option. The procedure can also protect patients against having a stroke caused by an abnormal heart rhythm (Afib), which has been associated with an increased risk of stroke.
During the procedure, a 3 mm puncture hole is made in the pericardium surrounding the patient’s heart. Guide wires fitted with strong magnets are threaded through the hole and used to establish a track to the LAA. The cardiologist then uses the LARIAT to follow the track and slip a lasso (a pre-tied suture loop) over the LAA, which can then be tightened under X-ray and ultrasound guidance, occluding the blind sac.
Not everyone is eligible for this procedure though. Some patients are considered to be high-risk candidates and must continue to use anti-coagulants as Afib stroke management. However, if patients are approved for this therapy it means that they won’t have to suffer through an invasive surgery or continue to use anti-coagulants. “Nonsurgical options (performed percutaneously) generally mean less discomfort, and more rapid recovery,” said Hosakote Nagaraj, MD, interventional cardiologist with NHI. “That’s all very good for the patients, and in addition, it has the potential to decrease cost in the health-care system.”
The LARIAT procedure is a way for patients to manage their risk of stroke along with decreasing symptoms such as dizziness, fainting, or chest discomfort that is associated with Afib. This procedure is the least invasive way to manage Afib and is becoming a more common procedure in the United States.
“I was 100 percent behind it,” says Wolter. “I’ve been advising and telling people about this procedure. Different people react differently to any blood thinner. And now that there is no place for a clot to form, it gives me peace of mind to know that it reduces your risk.”