WATCHMAN PROCEDURE

 

The Watchman procedure is a medical intervention designed to reduce the risk of stroke in patients with atrial fibrillation (AFib), especially those who have a reason to seek an alternative to long-term use of blood thinners (anticoagulants). Here's a brief overview of the procedure:

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1. Purpose: The Watchman device is aimed at people with non-valvular atrial fibrillation. AFib increases the risk of stroke, and blood thinners are typically prescribed to reduce this risk. However, some patients can't tolerate blood thinners due to bleeding risks or other complications. The Watchman device offers an alternative.

2. The Device: The Watchman is a small, parachute-shaped device. It's designed to close off the left atrial appendage (LAA), a small sac in the muscle wall of the left atrium of the heart. In AFib, blood can pool in the LAA, forming clots that might travel to the brain and cause a stroke. By sealing off the LAA, the risk of such stroke-causing clots is reduced.

3. Procedure: The procedure is minimally invasive and typically done under general anesthesia. It involves a catheter that is inserted through a vein in the leg and guided to the heart. The Watchman device is then positioned to seal off the LAA.

4. Post-Procedure Care: After the procedure, patients might need to stay on blood thinners for a short period. Over time, heart tissue grows over the device, permanently sealing off the LAA. Regular follow-ups are necessary to ensure the device is in the correct position and functioning as intended.

5. Benefits and Risks: The main benefit of the Watchman device is reducing stroke risk without the need for long-term use of blood thinners, thereby also reducing the risk of bleeding complications associated with these drugs. However, as with any medical procedure, there are risks, including complications from the implantation process, potential device-related problems, and the risk that the LAA is not completely sealed

                                                                                                 

                                                    Anesthetic Implications for Watchman Procedure

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Anesthesia type: General, sedation, local anesthesia

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Airway: ETT

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Preoperative:

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• Patients with persistent atrial fibrillation

• Patients may present with a variety of cardiac comorbidities 

• Have heparin and protamine available

• The Watchman procedure requires real-time TEE guidance and fluoroscopy

• The procedure will be canceled if a left atrial appendage (LAA) thrombus is discovered

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Intraoperative:

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• The doctor will obtain femoral venous access and access the left atrium via transseptal puncture

•  TEE guidance is used for assessment of left atrial appendage (LAA) thrombus, transseptal puncture, and device deployment 

• The Watchman device is deployed into the LAA

• The device permanently seals off the LAA

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Postoperative:

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• Anticoagulation reversal, removal of the venous sheaths, and achievement of hemostasis

• Smooth emergence

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Complications:

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• Pericardial effusion (causes hypotension)

• Cardiac tamponade

• Vascular complications

• Arrhythmias

• Stroke

• Air embolism

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Sources:

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Elisha, S. (2010). Case Studies in Nurse Anesthesia.

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Macksey, L. F. (2011). Surgical procedures and anesthetic implications: A handbook for nurse anesthesia practice. 

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Jaffe, R. A. (2020). Anesthesiologist's Manual of Surgical Procedures (6th ed.). 

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Singh-Radcliff, N. (2013). 5-Minute Anesthesia Consult.

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