Clinical relevance of incomplete device endothelialization after left atrial appendage closure

Abstract

This study aimed to assess the incidence, potential risk factors and clinical impact of incomplete device endothelialization (IDE) after left atrial appendage closure (LAAC). MethodsA total of 101 consecutive patients with nonvalvular atrial brillation (AF) who underwent successful LAAC and received antithrombotic treatment using a standard regimen were prospectively followed up to 6 months after the procedure. The status of device endothelialization and device-related thrombus (DRT) were evaluated using cardiac computed tomography (CT). Major adverse cardio-cerebral events (MACCE) including all-cause death, heart failure(HF) hospitalization, acute ischemic stroke, transient ischemic attack(TIA), peripheral vascular embolism, and major bleeding were recorded. ResultsIDE was detected in 65 (64.4%) patients. Patients with IDE or complete device endothelialization (CDE) did not signi cantly differ with respect to baseline clinical characteristics and interventional procedure features. Multivariate analysis model revealed that persistent AF, left atrial appendage ostial diameter and left atrial size were independent risk factors for IDE. During 6-month follow-up, the incidence of DRT was 4.6% in patients with IDE and 2.8% in those with CDE, respectively (p > 0.05), and the overall rate of MACCE was non-signi cantly higher in the IDE group (7.7% vs. 2.8%, p = 0.32). ConclusionsIDE is common after LAAC, especially in patients with persistent AF, higher left atrial appendage ostial diameter and left atrial size. IDE confers an increased risk for DRT, but may be not necessarily associated with thromboembolic events and poor clinical outcome, providing careful monitoring and continued antithrombotic therapy are given.

Prognostic Impact of Left Atrial Appendage Patency After Device Closure

“…There was only one short-term (6 months) study showing that delayed endothelialization conferred an increased risk for device-related thrombus, but not for stroke and other clinical adverse events. 23 In this study with a larger sample size and long-term follow-up, LAA patency without visible PDL detected by 3-month CCTA increased the risks of stroke and MAEs, therefore, for the first time suggesting IDE also resulted in unfavorable long-term prognosis. Ways, both clinical- and materials-wise, should be explored to accelerate the process of device endothelialization.…”

“…IDE (as known as intradevice or transfabric leak), which refers to the continuous contrast enhancement through the incomplete endothelialized fabric membrane, might be the most common mechanism. 23 However, microgaps or microleaks in the circumference of the device (due to the device frame architecture), which could not be seen on CCTA, might be another potential explanation. Therefore, we used the term LAA patency without visible PDL instead of IDE under such consideration.…”