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Left atrial appendage occlusion in chicken-wing anatomies: Imaging assessment, procedural, and clinical outcomes of the "sandwich technique"

Research output: Contribution to journalJournal articleResearchpeer-review


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  • Xavier Freixa
  • Apostolos Tzikas
  • Adel Aminian
  • Eduardo Flores-Umanzor
  • Ole De Backer
  • Kasper Korsholm
  • Mohamed Ben Yedder
  • Rocío Gonzalez-Ferreiro
  • Victor Agudelo-Montañez
  • Thomas Gilhofer
  • François Simon
  • Athanasios Samaras
  • Ander Regueiro
  • Lars Sondergaard
  • Ignacio Cruz-Gonzalez
  • Dabit Arzamendi
  • Jacqueline Saw
  • Reda Ibrahim
  • Jens Erik Nielsen-Kudsk
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OBJECTIVES: To describe imaging assessment, procedural and follow-up outcome of patients undergoing left atrial appendage (LAA) occlusion (LAAO) using a "sandwich" technique.

BACKGROUND: The presence of a LAA with chicken wing morphology constitutes a challenge that sometimes requires specific occlusion strategies like the "sandwich" technique. However, procedural and follow-up data focusing on this implanting strategy is scarce.

METHODS: This multicenter study collected individual data from eight centers between 2012 and 2019. Consecutive patients with chicken-wing LAAs defined as an early (<20 mm from the ostium) and severe bend (>90°) who underwent LAAO with Amplatzer devices and using the "sandwich" technique were included in the analysis.

RESULTS: Overall, 190 subjects were enrolled in the study. Procedures were done with the Amulet device (85%) and the Amplatzer Cardiac Plug (15%). Successful implantation was achieved in 99.5% with ≤1 partial recapture in 80% of cases. Single (46.2%) and dual antiplatelet therapy (39.4%) were the most used antithrombotic therapies after LAAO. In-hospital major adverse events rate was 1.5% with no deaths. One patient (0.5%) had cardiac tamponade requiring percutaneous drainage. With a mean follow-up of 19.6 ± 14.8 months, the mortality and stroke rates were 7.7%/year and 2.5%/year, respectively. Follow-up transesophageal echocardiography (TEE) at 2-3 months showed device-related thrombosis in 2.8% and peri-device leak ≥3 mm in 1.2% of patients.

CONCLUSIONS: In a large series of patients with chicken wing LAA anatomies undergoing LAAO, the use of the "sandwich" technique was feasible and safe. Preprocedural imaging was a key-factor to determine specific measurements.

Original languageEnglish
JournalCatheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions
Issue number7
Pages (from-to)E1025-E1032
Publication statusPublished - 1 Jun 2021

Bibliographical note

© 2021 Wiley Periodicals LLC.

    Research areas

  • Atrial Appendage/diagnostic imaging, Atrial Fibrillation/diagnostic imaging, Echocardiography, Transesophageal, Humans, Stroke, Treatment Outcome

ID: 72630899