Left Atrial Appendage Occlusion (LAAO or also often called a Watchman procedure) is done to prevent bleeding and strokes in patients with Atrial Fibrillation (AF) who cannot take blood thinners such as Xarelto, Eliquis or Warfarin due to bleeding. The bleeding can be from any source, but common ones include bleeding from the stomach or bowels (GI Bleeding), bleeding in the brain (Subdural Haematoma or intracranial haemorrhage / haemorrhagic stroke) or bleeding in the urine(haematuria).
The LAAO is done to plug a pouch in the heart, called the appendage, which is like the appendix in the bowel (in that it has no function in human life). The appendage is where 90% of blood clots in the heart form and so plugging this pouch prevents the blood clots forming and then traveling to the brain (or other organs) to cause a stroke.
Most people in Australia are put on blood thinners when they are diagnosed with AF, the Watchman procedure is done for people who cannot tolerate the blood thinners.
• A CT scan is usually performed in the weeks leading up to the procedure to assist with planning and assessment.
• You will generally be admitted to hospital on the morning of the procedure.
• On the day of the procedure, you must not eat or drink anything unless specifically instructed otherwise.
• You should also withhold your usual medications on the morning of the procedure unless directed by Dr Hilling-Smith or the hospital team.
• The procedure is performed under a general anaesthetic to ensure your comfort throughout.
• The closure device is inserted through a small 4 mm tube placed in a vein at the top of the leg. No surgical incision or cutting is required.
• While you are asleep, a specialised ultrasound camera called a trans-oesophageal echocardiogram (TOE) is placed in the oesophagus to help guide the device into the correct position.
• The procedure typically takes approximately 90 minutes to complete.
• You will remain in hospital overnight following the LAAO procedure.
• It is common to experience a mild sore throat from the breathing tube and trans-oesophageal echocardiogram (TOE), as well as some bruising at the groin access site.
• You will usually be prescribed gentle blood-thinning medications, such as aspirin and clopidogrel, for approximately 6 weeks, together with a short course of antibiotics for one week.
• An echocardiogram will be performed the following morning to assess the position of the device, and most patients are able to return home around lunchtime.• You must not drive for 2 days after the procedure.
• Until your clinical review and follow-up echocardiogram at approximately 6 weeks, you should avoid strenuous activities, including heavy lifting (more than 10 kg), gym workouts and swimming.
• These restrictions help prevent strain on the chest and allow the device to settle securely into position during the healing process.
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