First results of the Brazilian Registry of Percutaneous Left Atrial Appendage Closure

Abstract

BackgroundLeft atrial appendage closure (LAAC) is an effective alternative to oral anticoagulation (OA) for the prevention of stroke in patients with non-valvular atrial fibrillation (NVAF).ObjectiveTo present the immediate results and late outcomes of patients submitted to LAAC and included in the Brazilian Registry of Percutaneous Left Atrial Appendage Closure.Methods91 patients with NVAF, high stroke risk (CHA2DS2VASc score = 4.5 ± 1.5) and restrictions to OAC (HAS-BLED score = 3.6 ± 1.0) underwent 92 LAAC procedures using either the Amplatzer cardiac plug or the Watchman device in 11 centers in Brazil, between late 2010 and mid 2016.ResultsNinety-six devices were used (1.04 device/procedure, including an additional non-dedicated device), with a procedural success rate of 97.8%. Associated procedures were performed in 8.7% of the patients. Complete LAAC was obtained in 93.3% of the successful cases. In cases of incomplete closure, no residual leak was larger than 2.5 mm. One patient needed simultaneous implantation of 2 devices. There were 7 periprocedural major (5 pericardial effusions requiring pericardiocentesis, 1 non-dedicated device embolization and 1 coronary air embolism without sequelae) and 4 minor complications. After 128.6 patient-years of follow-up there were 3 deaths unrelated to the procedure, 2 major bleedings (one of them in a patient with an unsuccessful LAAC), thrombus formation over the device in 2 cases (both resolved after resuming OAC for 3 months) and 2 strokes (2.2%).ConclusionsIn this multicenter, real world registry, that included patients with NVAF and high thromboembolic and bleeding risks, LAAC effectively prevented stroke and bleeding when compared to the expected rates based on CHA2DS2VASc and HASBLED scores for this population. Complications rate of the procedure was acceptable considering the beginning of the learning curve of most of the involved operators.

Meta-analysis of postoperative antithrombotic therapy after left atrial appendage occlusion

“…After reading the abstract and partial text of each study, unrelated studies, reviews, case reports, studies with unclear outcomes or incomplete data, and studies in which LAAO was combined with other surgeries were excluded. Finally, 32 studies 13 – 44 that satisfied the selection criteria were included in this meta-analysis ( Figure 1 ).…”

Left Atrial Appendage Transcatheter Occlusion with AMPLATZERT AmuletT Device: Real Life Data with Mid-Term Follow-Up Results

“…Our procedural success rate was similar to previous studies. [11][12][13] Landmesser et al 12 reported that the procedural success of LAA occlusion with the Amulet device was 99.0% in their multicenter registry, which included 1,088 patients. 12 They reported peri-device leak in 2% of patients during follow-up.…”

Percutaneous Occlusion of Left Atrial Appendage: Growing Clinical Experience and Lack of Multicenter Randomized Clinical Trials

“…Two Brazilian registries have been recently published and suggested the safety of appendage occlusion device implantation. Guerios et al, 12 performed a multicenter registry and evaluated the results of 91 patients with nonvalvular AF (62% ineligible for anticoagulation) and high risk of stroke (CHA2DS2VASc 4.5 ± 1.5), submitted to the implantation of 96 prostheses, with the ACP (Amplatzer Cardiac Plug) being implanted in 94.6%. The implant success rate was 97.8%, with 7.2% of complications, with five pericardial effusions requiring pericardiocentesis, one non-dedicated device embolization and one gas embolism without sequelae.…”