Article of the Month – July 2020

Non-invasive Ventilation during Left Atrial Appendage Closure under Sedation: Preliminary Experience with the Janus Mask


DOI: 10.4103/aca.ACA_145_18

Published: Ann Card Anaesth. 2019 Oct-Dec; 22(4): 400–406

Authors: Alberto Zangrillo, Patrizio Mazzone, Alessandro Oriani, Marina Pieri, Giovanna Frau, Giuseppe D’Angelo, Chiara Sartini, Riccardo Capucci, Alessandro Belletti, Paolo Della Bella, Fabrizio Monaco

Article Description:

This is a retrospective case-control study of the use of non-invasive ventilation during left atrial appendage occlusion (LAAO).


  • During LAAO, transoesophageal echocardiography (TEE) is required in all patients to guide the transseptal puncture and to have a full view of the LAA.
  • Percutaneous LAAO is frequently performed in old, frail patients with several comorbidities which increase the risks of complications of general anesthesia.
  • The possibility of undergoing LAAO under procedural sedation is attractive.
  • The authors compared 11 patients undergoing LAAO under sedation with assisted spontaneous ventilation using the Janus Mask, a device designed for endoscopic procedures, with 11 patients underwent LAAO received general anaesthesia. 
  • Patients in the Janus Mask group showed increased PaCO2 which led to a transient pH decrease 45 min after the beginning of the procedural sedation
  • No differences in the intraoperative haemodynamic parameters, oxygenation and discharge criteria were noted.
  • Surgeons and anaesthesiologists showed comparable satisfaction with both techniques of anaesthesia.
  • Three cases in the Janus mask group developed transient intraoperative apnoea which were treated with reduction of sedation without further apparent complications.
  • This preliminary study demonstrated the feasibility and safety of the procedural sedation with assisted spontaneous ventilation using the Janus Mask as an alternative to general anaesthesia during the LAAO procedures.

Check this interesting study and look for the results: would this be a plus or change your practice? 

Follow us and join the upcoming EACTA polls on Facebook, Instagram, Twitter and LinkedIn: we look forward to hearing from you!

Leave a Comment