Does peri-device leak after left atrial appendage closure impact patient outcome? - 05/01/18
Résumé |
Background |
Limited studies reported the rate and clinical impact of peri-device leaks (PDL) after percutaneous left atrial appendage closure (LAAC).
Method |
All consecutive patients admitted for LAAC between November 2011 and October 2016 (n=83) were prospectively enrolled. LAAC was performed under sedation using fluoroscopy and trans-esophageal echocardiography (TEE) monitoring. The follow-up included clinical, TEE and/or cardiac computed tomography angiography (CCTA). PDL was defined by the presence of contrast within the LAA on CCTA, and MACE included stroke, device-related thrombosis and cardiovascular death. LAAC failures (n=3) and patients without imaging during follow-up were excluded (n=10).
Results |
Overall, 70 patients (mean age 75±8 years, mean CHA2DS2-VASc=4.4±1.5 and mean HAS-BLED 3.4±1.1) were implanted using Amplatzer Cardiac Plug (n=24), Amulet (n=32) or Watchman devices (n=14). Indications were stroke recurrence under optimal treatment (n=7) or contraindication to anticoagulation (n=63). After LAAC, patients with a contraindication to anticoagulation received antiplatelet therapy alone (aspirin alone, n=33). On CCTA at 3, 6 and 12 months, PDL was observed respectively in 70% (46/66), 64% (27/42) and 50% (13/26) of patients. Patients with PDL had a larger LAA diameter (21±3mm vs. 18±3mm, P=0.01) and a lower prosthesis compression (13±7% vs. 9±7%, P=0.02). During follow-up (median 261 days [147–399]), MACE were observed in 7.1% of patients including 2 strokes, 2 device-related thrombosis, and 1 cardiovascular death. The presence of a PDL was not associated with MACE.
Conclusion |
PDL is frequently observed (>50%) after LAAC and tends to decrease over the time. No association is observed between PDL and MACE.
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Vol 10 - N° 1
P. 59 - janvier 2018 Retour au numéro
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