Safety and feasibility of peri-device leakage closure after LAAO: an international, multicentre collaborative study

Piayda, Kerstin; Sievert, Kolja; Rocca, Domenico Giovanni Della; Adeola, Oluwaseun; Alkhouli, Mohamad; Yoo, David; Benito‐González, Tomas; Cruz-González, Ignatio; Galea, Roberto; Skurk, Carsten; Nielsen‐Kudsk, Jens Erik; Grygier, Marek; Beaty, Elijah; Newton, Jim; Prado, Armando Pérez de; Räber, Lorenz; Gibson, Douglas; Niekerk, Christoffel Van; Ellis, Christopher R.; Horton, Rodney; Grundwald, Iris; Zeus, Tobias; Sievert, Horst

doi:10.4244/eij-d-21-00286

Cited by 17 publications

(13 citation statements)

References 30 publications

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“…Up to this time, the consensus remains that a PDL > 5 mm is defined as incomplete LAAO and requires either continuation of anticoagulation or interventional leak closure. These patients are more likely to remain on anticoagulants 30 negating the benefit of LAA closure and may undergo further interventional procedures to achieve full LAA exclusion 32 . Emerging data from the NCDR‐LAAO Registry showed that even small leaks (<5 mm) were associated with a modest but statistically significant increase in the risk of stroke, transient ischemic attack and systemic embolization at 1 year 33 .…”

Section: Discussionmentioning

confidence: 99%

“…These patients are more likely to remain on anticoagulants 30 negating the benefit of LAA closure and may undergo further interventional procedures to achieve full LAA exclusion. 32 Emerging data from the NCDR-LAAO Registry showed that even small leaks (<5 mm) were associated with a modest but statistically significant increase in the risk of stroke, transient ischemic attack and systemic embolization at 1 year. 33 Long-term follow-up data from PROTECT AF, PREVAIL, and CAP-2 also documented that small leaks that persisted beyond 1 year were associated with higher odds of stroke/systemic embolization at 5 years.…”

Section: Discussionmentioning

confidence: 99%

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The CT derived angle between the transseptal puncture site and the left atrial appendage as a predictor for complex interventional occlusion procedures

Nelles,

Amli,

Sugiura

et al. 2023

Echocardiography

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ObjectiveTo evaluate the role of the CT‐derived angle between the intra‐atrial septum (IAS) and the left atrial appendage (LAA) on procedural complexity and clinical outcomes in left atrial appendage occlusion (LAAO) procedures.BackgroundGiven the broad variations in anatomy, LAAO remains one of the most challenging interventional procedures in structural heart disease. In recent years, preprocedural cardiac tomography (CT) has evolved as a valuable tool; however, prediction of procedural complexity remains cumbersome.MethodsWe retrospectively analyzed 47 patients that underwent LAAO at our center in whom pre‐procedural cardiac CT‐scans were available. Among other baseline parameters, we measured the angle between the LAA ostium and the preferred transseptal puncture site at the IAS. We compared patients with an angle above and below the median regarding procedural characteristics and procedural outcome.ResultsThe median angle between the LAA and the IAS was 127.3° (IQR: 120.9–141.3). LAAO took longer in patients with a measured angle below the median (55.0 ± 22.7 min vs. 41.3 ± 17.5 min; p = .04), resulting in longer radiation times (13.0 ± 5.3 min vs. 9.8 ± 5.7 min; p = .04) and more contrast use (61.1 ± 47.5 mL vs. 33.6 ± 24.7 mL; p = .05). Moreover, the necessity for a sheath exchange was significantly higher (30.4% vs. 4.2%, p = .02) and device repositioning or device resizing trended to be more frequent (26.1% vs. 8.3%; p = .1 and 21.7% vs. 8.3%; p = .2). There were no differences in procedural outcome, device‐position and peri‐device leak (PDL).ConclusionsThe angle between the transseptal puncture site and the LAA ostium may serve as a predictor for more demanding LAAO interventions. In our study a steeper angle led to a prolonged procedure resulting in higher doses of contrast and radiation, but was not associated with a worse procedural outcome.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The CT derived angle between the transseptal puncture site and the left atrial appendage as a predictor for complex interventional occlusion procedures

Nelles,

Amli,

Sugiura

et al. 2023

Echocardiography

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“…No study has specifically assessed the net clinical benefit of continuing OAC in patients with PDL. Several single and multicentre studies have reported the outcomes of percutaneous closure using coils, plugs, and occluders 93,[96][97][98] and suggested that interventional closure of PDL is safe and effective in achieving complete closure of the LAA. Although patients who underwent PDL closure had low thromboembolic and bleeding event rates after leak closure, the limited follow-up and retrospective nature of these studies precludes solid conclusions.…”

Section: Pdl Managementmentioning

confidence: 99%

Left atrial appendage occlusion

Holmes¹,

Korsholm²,

Rodés‐Cabau³

et al. 2023

EuroIntervention

110

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Prevention of stroke represents a goal of primary importance in health systems due to its associated morbidity and mortality. As several patient groups with increased stroke rates have been identified, multiple approaches have been developed and implemented: oral anticoagulation (OAC) for patients with atrial fibrillation, surgical and percutaneous revascularisation in patients with carotid disease, device closure for patients with patent foramen ovale, and now, left atrial appendage occlusion (LAAO) for selected patients with non-valvular atrial fibrillation (NVAF). The latter group of patients are the focus of this review which evaluates the pathophysiology, selection of patients, procedural performance, outcomes of treatment both during and post-procedure, adjunctive therapy, complications, and longer-term outcomes. KEYWORDS • anticoagulation • atrial fibrillation • ischaemic stroke • left atrial appendage occlusion e 1039

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“…21 The feasibility of placing another transcatheter device following failed surgical occlusion has been documented. [22][23][24][25] For smaller leaks, detachable coils have been used to close residual leaks after transcatheter and surgical LAA occlusion. 26 A recent multicenter experience of 72 patients with either Watchman devices (53 patients) or surgical LAA (19 patients) has been reported.…”

Section: Management Of Incomplete Laa Closurementioning

confidence: 99%