Ancillary services
Multidisciplinary team/Outpatient clinic
• Optimally, an LAA occlusion program should be embedded in a
comprehensive AF and structural heart program to allow for comprehensive
patient care.
▶ The composition of the multidisciplinary team (MDT) caring for the
patient will vary from site to site.
» In addition to an electrophysiologist and/or interventional cardiologist
(pediatric or adult) or cardiovascular surgeon fully trained in structural
heart disease procedures, who will be the primary operator(s) for the
procedure, physicians with expertise in procedure-guided TEE, ICE, or
management of AF should be available.
▶ The composition of the implanting team will vary from center to center.
» In some institutions, physician teams, consisting of a primary operator
along with an assistant or co-operator, may jointly perform the procedure
to offer the greatest expertise and to optimize procedural success and
safety.
» In other highly experienced centers, a single procedural specialist may be
adequate for device implantation.
▶ Physician specialists and technologists skilled in CT and other imaging
modality interpretation should be available if procedures that require CT
imaging are performed.
▶ In addition, a non-physician provider (nurse, nurse practitioner, physician
assistant) could be helpful in facilitating the MDT approach.
Cardiac surgery
A cardiac surgeon, anesthesiologist, and perfusionist should be on site for surgical
backup.
Cardiac surgery operating rooms should be readily available in the rare event of a
major complication requiring surgical intervention.
Post-procedural care
• After undergoing LAA occlusion, patients can be managed in a post-anesthesia
care unit, intensive care unit, or telemetry unit.
▶ Personnel experienced in managing patients undergoing complex cardiac
procedures must be present.
Blood bank
• A blood bank does not have to be on site. However, it is prudent that patients
be typed and screened, with packed red-blood cells available if needed.
Key Institutional Requirements (cont'd)
