Systematic review and meta-analysis of left atrial appendage closure's influence on early and long-term mortality and stroke

Kowalewski, Mariusz; Święczkowski, Michał; Kuźma, Łukasz; Maesen, Bart; Dąbrowski, Emil Julian; Matteucci, Matteo; Batko, Jakub; Litwinowicz, Radosław; Kowalówka, Adam; Wańha, Wojciech; Jiritano, Federica; Raffa, Giuseppe Maria; Malvindi, Pietro Giorgio; Pannone, Luigi; Meani, Paolo; Lorusso, Roberto; Whitlock, Richard; La Meir, Mark; de Asmundis, Carlo; Cox, James; Suwalski, Piotr

doi:10.1016/j.xjon.2024.02.022

JTCVS Open

2024

DOI: 10.1016/j.xjon.2024.02.022

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Systematic review and meta-analysis of left atrial appendage closure's influence on early and long-term mortality and stroke

Mariusz Kowalewski,

Michał Święczkowski,

Łukasz Kuźma

et al.

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2024

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Cited by 3 publications

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A Comprehensive Review of Percutaneous and Surgical Left Atrial Appendage Occlusion

Święczkowski,

Dąbrowski,

Muszyński

et al. 2024

JCDD

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Atrial fibrillation (AF) is the most common arrhythmia worldwide, and is associated with a significant risk of thromboembolic events. Left atrial appendage occlusion (LAAO) has emerged as a promising alternative for patients with contraindications or intolerance to anticoagulant therapy. This review summarises the current evidence, indications, and technical advancements in surgical and percutaneous LAAO. Preprocedural planning relies on various imaging techniques, each with unique advantages and limitations. The existing randomised clinical trials and meta-analyses demonstrate favourable results for both percutaneous and surgical LAAO. Postprocedural management emphasises personalised anticoagulation strategies and comprehensive imaging surveillance to ensure device stability and detect complications. Future focus should be put on antithrombotic regimens, investigating predictors of device-related complications, and simplifying procedural aspects to enhance patient outcomes. In summary, LAAO is presented as a valuable therapeutic option for preventing AF-related thromboembolic events, with ongoing research aimed at refining techniques and improving patient care.

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A Comprehensive Review of Percutaneous and Surgical Left Atrial Appendage Occlusion

Święczkowski,

Dąbrowski,

Muszyński

et al. 2024

JCDD

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Device-Assisted Left Atrial Appendage Exclusion: From Basic Sciences to Clinical Applications

Karpierz,

Piotrowski,

Bartuś

et al. 2024

JCDD

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Device-assisted left atrial appendage exclusion plays a crucial role in the prevention of fatal ischemic complications in patients with atrial fibrillation and contraindications to anticoagulation treatment. Various devices with different safety profiles and device-related complications are available in daily practice to perform this procedure. In this review, the anatomy, physiology, and functions of the left atrial appendage were detailed, and all available devices used for epicardial and endocardial exclusion of the left atrial appendage and their clinical outcomes were discussed. Future research should aim to further investigate the long-term effects of left atrial appendage exclusion on body homeostasis, blood coagulation, and cardiac function.

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First-in-Human Percutaneous Epicardial-Only Left Atrial Appendage Closure Using Sierra Left Atrial Appendage Ligation System

Batko,

Litwinowicz,

Kapelak

et al. 2024

JCM

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Background: In patients with atrial fibrillation and contraindications for oral anticoagulation, in which an increased risk of stroke remains, a left atrial appendage exclusion should be considered for elimination, because the left atrial appendage is the most common site of thrombus. The aim of this study is to present the first-in-human study results of the Sierra Aegis Left Atrial Appendage Ligation System, a new epicardial-only left atrial appendage closure system. Methods: This study was a prospective, first-in-human, single-center study evaluating the effectiveness and safety of the Sierra Aegis Left Atrial Appendage Ligation System device for epicardial left atrial appendage closure. Seven patients (mean age: 57.3 ± 10.6 years, 71.4% male) were qualified for a left atrial appendage closure because of an increased risk of bleeding with the need for lifelong anticoagulation pharmacology due to an increased risk of stroke. The patients’ preoperative and intraoperative characteristics were collected. Patients were observed during their 1-month, 3-month, 6-month, and 1-year follow-up. Results: The mean procedure time was 21.2 ± 8.2 min. All patients spent 3 days in the hospital including monitoring, the performance of preoperative CT scans, and anatomical evaluation. No tamponade, bleeding, thrombus, or left atrial appendage leakage were observed during the procedure or in-hospital stay. During the 1-month, 3-month, 6-month, and 1-year follow-up visits, none of the patients reported any complications. No tamponade, leakage, or left atrial appendage thrombus were observed. Conclusions: This first-in-human study regarding Sierra use for left atrial appendage closure shows promising results regarding the effectiveness and safety of the Sierra device for use in humans.

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Systematic review and meta-analysis of left atrial appendage closure's influence on early and long-term mortality and stroke

Cited by 3 publications

References 87 publications

A Comprehensive Review of Percutaneous and Surgical Left Atrial Appendage Occlusion

A Comprehensive Review of Percutaneous and Surgical Left Atrial Appendage Occlusion

Device-Assisted Left Atrial Appendage Exclusion: From Basic Sciences to Clinical Applications

First-in-Human Percutaneous Epicardial-Only Left Atrial Appendage Closure Using Sierra Left Atrial Appendage Ligation System

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