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Blanco-Fernández F, Antúnez-Muiños PJ, Núñez-García JC, López-Tejero S, Barreira-de Sousa GJ, García-Monsalvo M, Antúnez-Ballesteros M, Maree A, González-Calle D, Rodríguez-Collado J, Barreiro-Pérez M, Díaz-Peláez E, Pérez del Villar-Moro MC, Sánchez-Fernández PL, Cruz-González I. Effectiveness and Safety of an Outpatient Program for Percutaneous Left Atrial Appendage Occlusion. J Clin Med 2023; 12:6728. [PMID: 37959194 PMCID: PMC10648316 DOI: 10.3390/jcm12216728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/07/2023] [Accepted: 10/08/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Left atrial appendage occlusion (LAAO) is a safe and effective alternative to oral anticoagulation for thromboprophylaxis in patients with nonvalvular atrial fibrillation. Technological development in devices and imaging techniques, as well as accumulated experience, have increased procedural success rates and decreased complications. Same-day discharge protocols have been proposed in the field of structural heart disease, but this approach has not been studied in detail for the LAAO procedure. AIM The aim of this study is to assess the safety and efficacy of an outpatient program for LAAO when compared to the conventional treatment approach. METHODS We present a retrospective, non-randomized single-center study of 262 consecutive patients undergoing LAAO. Patients were divided into two groups, the first (n = 131) followed a conventional protocol (CP), and the second (n = 131) an outpatient protocol (OP). The primary composite endpoint comprised MACCE (death, stroke, and bleeding), cardiac tamponade, vascular complication, or attendance in the emergency department after hospital discharge at 30 days. RESULTS The overall success rate was 99.6%, with a periprocedural complication rate of 2.29%. With regards to the CP versus OP group, there were no differences between incidences of the primary composite endpoint (6.1% PC vs. 3.0% PA, p = 0.24), or after an analysis, with propensity score matching. No differences were observed in the individual endpoints. There was a decrease in hospital length of stay in the same-day discharge group (p < 0.01). CONCLUSIONS A same-day discharge LAAO program is safe, effective, and feasible when compared to the conventional strategy. Moreover, it reduces hospital length of stay, which might have clinical and economic benefits.
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Affiliation(s)
- Fabián Blanco-Fernández
- Department of Cardiology, Hospital Universitario de Salamanca, 37007 Salamanca, Spain (G.J.B.-d.S.)
- Instituto de Investigación Biomédica de Salamanca, 37007 Salamanca, Spain
- Centro de Ivestigación Biomédica en Red—Enfermedades Cardiovasculares (CIBER-CV), 37007 Salamanca, Spain
| | - Pablo J. Antúnez-Muiños
- Department of Cardiology, Hospital Universitario de Salamanca, 37007 Salamanca, Spain (G.J.B.-d.S.)
- Instituto de Investigación Biomédica de Salamanca, 37007 Salamanca, Spain
- Centro de Ivestigación Biomédica en Red—Enfermedades Cardiovasculares (CIBER-CV), 37007 Salamanca, Spain
| | | | - Sergio López-Tejero
- Department of Cardiology, Hospital Universitario de Salamanca, 37007 Salamanca, Spain (G.J.B.-d.S.)
- Instituto de Investigación Biomédica de Salamanca, 37007 Salamanca, Spain
- Centro de Ivestigación Biomédica en Red—Enfermedades Cardiovasculares (CIBER-CV), 37007 Salamanca, Spain
| | - Gilles J. Barreira-de Sousa
- Department of Cardiology, Hospital Universitario de Salamanca, 37007 Salamanca, Spain (G.J.B.-d.S.)
- Instituto de Investigación Biomédica de Salamanca, 37007 Salamanca, Spain
- Centro de Ivestigación Biomédica en Red—Enfermedades Cardiovasculares (CIBER-CV), 37007 Salamanca, Spain
| | - Mónica García-Monsalvo
- Department of Cardiology, Hospital Universitario de Salamanca, 37007 Salamanca, Spain (G.J.B.-d.S.)
- Instituto de Investigación Biomédica de Salamanca, 37007 Salamanca, Spain
- Centro de Ivestigación Biomédica en Red—Enfermedades Cardiovasculares (CIBER-CV), 37007 Salamanca, Spain
| | - Milena Antúnez-Ballesteros
- Department of Cardiology, Hospital Universitario de Salamanca, 37007 Salamanca, Spain (G.J.B.-d.S.)
- Instituto de Investigación Biomédica de Salamanca, 37007 Salamanca, Spain
- Centro de Ivestigación Biomédica en Red—Enfermedades Cardiovasculares (CIBER-CV), 37007 Salamanca, Spain
| | | | - David González-Calle
- Department of Cardiology, Hospital Universitario de Salamanca, 37007 Salamanca, Spain (G.J.B.-d.S.)
- Instituto de Investigación Biomédica de Salamanca, 37007 Salamanca, Spain
- Centro de Ivestigación Biomédica en Red—Enfermedades Cardiovasculares (CIBER-CV), 37007 Salamanca, Spain
| | - Javier Rodríguez-Collado
- Department of Cardiology, Hospital Universitario de Salamanca, 37007 Salamanca, Spain (G.J.B.-d.S.)
- Instituto de Investigación Biomédica de Salamanca, 37007 Salamanca, Spain
- Centro de Ivestigación Biomédica en Red—Enfermedades Cardiovasculares (CIBER-CV), 37007 Salamanca, Spain
| | | | - Elena Díaz-Peláez
- Department of Cardiology, Hospital Universitario de Salamanca, 37007 Salamanca, Spain (G.J.B.-d.S.)
- Instituto de Investigación Biomédica de Salamanca, 37007 Salamanca, Spain
- Centro de Ivestigación Biomédica en Red—Enfermedades Cardiovasculares (CIBER-CV), 37007 Salamanca, Spain
| | - María C. Pérez del Villar-Moro
- Department of Cardiology, Hospital Universitario de Salamanca, 37007 Salamanca, Spain (G.J.B.-d.S.)
- Instituto de Investigación Biomédica de Salamanca, 37007 Salamanca, Spain
- Centro de Ivestigación Biomédica en Red—Enfermedades Cardiovasculares (CIBER-CV), 37007 Salamanca, Spain
| | - Pedro L. Sánchez-Fernández
- Department of Cardiology, Hospital Universitario de Salamanca, 37007 Salamanca, Spain (G.J.B.-d.S.)
- Instituto de Investigación Biomédica de Salamanca, 37007 Salamanca, Spain
- Centro de Ivestigación Biomédica en Red—Enfermedades Cardiovasculares (CIBER-CV), 37007 Salamanca, Spain
| | - Ignacio Cruz-González
- Department of Cardiology, Hospital Universitario de Salamanca, 37007 Salamanca, Spain (G.J.B.-d.S.)
- Instituto de Investigación Biomédica de Salamanca, 37007 Salamanca, Spain
- Centro de Ivestigación Biomédica en Red—Enfermedades Cardiovasculares (CIBER-CV), 37007 Salamanca, Spain
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Contemporary Percutaneous Left Atrial Appendage Occlusion Devices Have Same Long-Term Clinical Outcomes: A Meta-Analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 46:115-116. [PMID: 36028383 DOI: 10.1016/j.carrev.2022.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/08/2022] [Accepted: 08/15/2022] [Indexed: 01/13/2023]
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Bai Y, Tang X, Xu X, Zhao X, Xu Y, Chen W, Zhu X, Wang Q, Han Z, Wang C, He L, Zhang Y, Pan X, Wang C, Chen L, Cen X, Qu B, Zhu N, Zhang S, Huang X, Qin Y. A newly designed disk-lobe occluder with isogenous barbs for left atrial appendage closure: Initial multicenter experience. Front Cardiovasc Med 2022; 9:974994. [PMID: 36119731 PMCID: PMC9478548 DOI: 10.3389/fcvm.2022.974994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/15/2022] [Indexed: 11/16/2022] Open
Abstract
Background Although the implant success rate of left atrial appendage closure (LAAC) has increased and complications have decreased over time, there are still anatomically and technically complicated cases where novel LAA occluders may simplify the procedure and thus might potentially improve the clinical outcome. Objectives This study aimed to assess the safety and efficacy of the newly designed device with isogenous barbs in LAAC. Methods Eight centers in China participated in this prospective study from July 2016 to April 2018. Peri- and post-procedural safety and efficacy were evaluated through scheduled follow-ups and transesophageal echocardiography (TEE). Results A total of 175 patients with a mean age of 68.4 ± 9.2 years old, a mean CHA2DS2-VASc score of 4.7 ± 1.8, and a mean HAS-BLED score of 3.2 ± 1.3, were included. The device was successfully implanted in 173 patients (98.9%). The device size ranged from 18 to 34 mm. Clinically relevant pericardial effusion (PEF) in the perioperative period, occurred in 3 patients (1.7%). TEE follow-up was available in 167 (96.5%) patients at 12-month. During follow-up, 9 patients suffered serious adverse event: 4 death (2.3%), 1 ischemic stroke (0.6%), and 2 gastro-intestinal bleeding (1.2%) and 2 device-related thrombus (DRT) (1.2%). Estimated annual thromboembolism rate reduced by 90% and estimated annual major bleeding rate reduced by 81% after LAAC with the newly designed device. Conclusion The newly designed device with isogenous barbs for LAAC could be performed effectively with a low incidence of adverse events and a high incidence of anatomic closure.
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Affiliation(s)
- Yuan Bai
- Department of Cardiology, Shanghai Changhai Hospital, Navy Military Medical University, Shanghai, China
| | - Xuechao Tang
- Department of Cardiology, The 960th Hospital of People’s Liberation Army, Tai’an, China
| | - Xudong Xu
- Department of Cardiology, Shanghai Changhai Hospital, Navy Military Medical University, Shanghai, China
| | - Xianxian Zhao
- Department of Cardiology, Shanghai Changhai Hospital, Navy Military Medical University, Shanghai, China
| | - Yawei Xu
- Department of Cardiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wei Chen
- Department of Cardiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xianyang Zhu
- Department of Congenital Heart Disease, General Hospital of Northern Theater Command, Shenyang, China
| | - Qiguang Wang
- Department of Congenital Heart Disease, General Hospital of Northern Theater Command, Shenyang, China
| | - Zhihua Han
- Department of Cardiology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Changqian Wang
- Department of Cardiology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lu He
- Department of Structural Heart Disease, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Yushun Zhang
- Department of Structural Heart Disease, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Xin Pan
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Cheng Wang
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Lianglong Chen
- Department of Cardiology, Fujian Medical University Affiliated Union Hospital, Fuzhou, China
| | - Xuejiang Cen
- Department of Cardiology, Zhejiang Provincial People’s Hospital, Hangzhou, China
| | - Baiming Qu
- Department of Cardiology, Zhejiang Provincial People’s Hospital, Hangzhou, China
| | - Ni Zhu
- Department of Cardiology, Shanghai Changhai Hospital, Navy Military Medical University, Shanghai, China
| | - Sha Zhang
- Department of Cardiology, Shanghai Changhai Hospital, Navy Military Medical University, Shanghai, China
| | - Xinmiao Huang
- Department of Cardiology, Shanghai Changhai Hospital, Navy Military Medical University, Shanghai, China
| | - Yongwen Qin
- Department of Cardiology, Shanghai Changhai Hospital, Navy Military Medical University, Shanghai, China
- *Correspondence: Yongwen Qin,
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Zhu MZ, Song H, Song GM, Bai X. Safety and efficacy of the Amplatzer amulet and watchman2.5 for left atrial appendage occlusion: a Systematic review and meta-analysis. Pacing Clin Electrophysiol 2022; 45:1237-1247. [PMID: 35933600 DOI: 10.1111/pace.14576] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 07/23/2022] [Accepted: 07/28/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Left atrial appendage occlusion (LAAO) is an alternative to oral anticoagulation (OAC) to decrease the risk of stroke in patients with nonvalvular atrial fibrillation (NVAF); however, certain complications remain a concern. Amplatzer Amulet and Watchman are the two most popular used devices for preventing stroke in patients with NVAF. We assessed the safety and efficacy of LAAO using the Amplatzer Amulet and Watchman. METHODS A meta-analysis was conducted to compare the safety and efficacy outcomes associated with the use of the Amplatzer Amulet and Watchman 2.5. The Newcastle-Ottawa Scale has been utilized to assess the quality of study. RESULTS The meta-analysis includes seven studies involving 2,926 patients (1,418 patients with an amulet and 1,508 with a Watchman 2.5). Generally, adverse event rates for both systems were minimal. No significant differences between the two devices were found in safety (pericardial effusion, device embolization, and cardiac tamponade) or efficacy outcomes (death, TIA, stroke, major/minor bleeding, device leak, and thromboembolic events). CONCLUSIONS The data suggest LAAO is a safe procedure, regardless of which device was used. LAAO devices generally have low complication rates. Outcomes were comparable between the two groups with no significant differences in their safety or efficacy. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Ming-Zhen Zhu
- Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, 107 West Wen Hua Road, Jinan, 250012, China
| | - Hao Song
- Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, 107 West Wen Hua Road, Jinan, 250012, China
| | - Guang-Min Song
- Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, 107 West Wen Hua Road, Jinan, 250012, China
| | - Xiao Bai
- Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, 107 West Wen Hua Road, Jinan, 250012, China
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Galea R, Räber L, Fuerholz M, Häner JD, Siontis GCM, Brugger N, Moschovitis A, Heg D, Fischer U, Meier B, Windecker S, Valgimigli M. Impact of Echocardiographic Guidance on Safety and Efficacy of Left Atrial Appendage Closure: An Observational Study. JACC Cardiovasc Interv 2021; 14:1815-1826. [PMID: 34412799 DOI: 10.1016/j.jcin.2021.05.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/27/2021] [Accepted: 05/27/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the impact of echocardiographic guidance on the safety and efficacy of left atrial appendage closure (LAAC). BACKGROUND Expert consensus documents recommend intraprocedural imaging by means of either transesophageal echocardiography or intracardiac echocardiography to guide LAAC. However, no evidence exists that intraprocedural echocardiographic guidance in addition to fluoroscopy improves the safety and efficacy of LAAC. METHODS Consecutive LAAC procedures performed at a high-volume center between January 2009 and October 2020 were stratified on the basis of intraprocedural imaging modalities, including fluoroscopic guidance (FG) only or intraprocedural echocardiographic guidance (EG) in addition to fluoroscopy. The primary safety endpoint was the composite of procedure-related complications occurring within 7 days after the procedure. Technical success at 7 days and at follow-up were secondary endpoints. RESULTS Among 811 LAAC procedures, 549 (67.7%) and 262 (32.3%) were assigned to the FG and EG groups, respectively. After adjusting for confounders, EG remained associated with a lower rate of the primary safety endpoint (3.4% vs 9.1%; P = 0.004; adjusted odds ratio [OR]: 0.31; 95% CI: 0.11-0.90; P = 0.030). Technical success trended higher at 7 days (92.1% vs 87.2%; P = 0.065; adjusted OR: 1.68; 95% CI: 0.95-3.01; P = 0.079) and was significantly improved with EG compared with FG (87.6% vs 79.9%; P = 0.018; OR: 4.06; 95% CI: 1.60-10.27; P = 0.003) after a median follow-up period of 4.9 months (interquartile range: 3.4 months-6.2 months). CONCLUSIONS In a large cohort of consecutive LAACs, the use of intraprocedural echocardiography to guide intervention in addition to standard fluoroscopy was associated with lower risks for procedural complications and higher mid-term technical success rates.
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Affiliation(s)
- Roberto Galea
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Monika Fuerholz
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jonas D Häner
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - George C M Siontis
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nicolas Brugger
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Aris Moschovitis
- Department of Cardiology, HerzZentrum Hirslanden, Zürich, Switzerland
| | - Dik Heg
- Department of Clinical Research, Clinical Trials Unit and Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Urs Fischer
- Department of Neurology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Bernhard Meier
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marco Valgimigli
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland; Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland.
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Labori F, Bonander C, Persson J, Svensson M. Clinical follow-up of left atrial appendage occlusion in patients with atrial fibrillation ineligible of oral anticoagulation treatment-a systematic review and meta-analysis. J Interv Card Electrophysiol 2021; 61:215-225. [PMID: 33580847 PMCID: PMC8324592 DOI: 10.1007/s10840-021-00953-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 02/01/2021] [Indexed: 10/26/2022]
Abstract
PURPOSE The recommended stroke prevention for patients with atrial fibrillation (AF) and increased risk of ischemic stroke is oral anticoagulation (OAC). Parts of the patient population are not eligible due to contraindication, and percutaneous left atrial occlusion (LAAO) can then be a preventive treatment option. The aim of this systematic review and meta-analysis is to estimate the long-term clinical effectiveness of LAAO as stroke prevention in patients with AF, increased risk of ischemic stroke, and contraindication to OAC. METHODS We performed a systematic review and meta-analysis, using Poisson random effect models, to estimate the incidence rate (events per 100 patient-years) of ischemic stroke, transient ischemic attack, major bleeding, and all-cause death after LAAO treatment. We also calculated the risk reduction of ischemic stroke with LAAO compared with no stroke prevention estimated through a predicted risk in an untreated population (5.5 per 100 patient-years). RESULTS We included 29 observational studies in our meta-analysis, including 7 951 individuals and 12 211 patient-years. The mean CHA2DS2-VASc score among the patients in the included studies is 4.32. The pooled incidence rate of ischemic stroke is 1.38 per 100 patient-years (95% CI 1.08; 1.77). According to a meta-regression model, the estimated incidence rate of ischemic stroke at CHA2DS2-VASc 4 is 1.39 per 100 patient-years. This implies a risk reduction of 74.7% with LAAO compared to predicated risk with no stroke prevention. CONCLUSIONS Our results suggest that LAAO is effective as stroke prevention for patients with AF, increased risk of stroke, and contraindication to oral anticoagulation.
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Affiliation(s)
- Frida Labori
- Health Economics and Policy, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Box 463, 405 30, Gothenburg, Sweden.
| | - Carl Bonander
- Health Economics and Policy, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Box 463, 405 30, Gothenburg, Sweden
| | - Josefine Persson
- Health Economics and Policy, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Box 463, 405 30, Gothenburg, Sweden
| | - Mikael Svensson
- Health Economics and Policy, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Box 463, 405 30, Gothenburg, Sweden
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Teiger E, Thambo JB, Defaye P, Hermida JS, Abbey S, Klug D, Juliard JM, Spaulding C, Armero S, Champagnac D, Bhugaloo H, Ternacle J, Lellouche N, Audureau E, Le Corvoisier P. Left atrial appendage closure for stroke prevention in atrial fibrillation: Final report from the French left atrial appendage closure registry. Catheter Cardiovasc Interv 2021; 98:788-799. [PMID: 34051135 DOI: 10.1002/ccd.29795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/10/2021] [Accepted: 05/19/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVES The French left atrial appendage (LAA) closure registry (FLAAC) aimed to assess the safety and efficacy of LAA closure in daily practice. BACKGROUND LAA closure has emerged as an alternative for preventing thromboembolic events (TE) in patients with non-valvular atrial fibrillation (NVAF). Clinical data in this field remains limited and few investigator-initiated, real-world registries have been reported. METHODS This nationwide, prospective study was performed in 36 French centers. The primary endpoint was the TE rate after successful LAA closure. RESULTS The FLAAC registry included 816 patients with a mean age of 75.5 ± 0.3 years, mean follow-up of 16.0 ± 0.3 months, high TE (CHA2 DS2 -VASc score: 4.6 ± 0.1) and bleeding risks (HAS-BLED score: 3.2 ± 0.05) and common contraindications to long-term anticoagulation (95.7%). Procedure or device-related serious adverse events occurred in 49 (6.0%) patients. The annual rate of ischemic stroke/systemic embolism was 3.3% (2.4-4.6). This suggests a relative 57% reduction compared to the risk of stroke in historical NVAF populations without antithrombotic therapy. By multivariate analysis, history of TE was the only factor associated with stroke/systemic embolism during follow-up (HR, 3.3 [1.58-6.89], p = 0.001). The annual mortality rate was 10.2% (8.4-12.3). Most of the deaths were due to comorbidities or underlying cardiovascular diseases and unrelated to the device or to TE. CONCLUSIONS Our study suggests that LAA closure can be an option in patients with NVAF. Long-term follow-up mortality was high, mostly due to comorbidities and underlying cardiovascular diseases, highlighting the importance of multidisciplinary management after LAA closure. REGISTRATION NCT02252861.
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Affiliation(s)
- Emmanuel Teiger
- Department of Cardiology, Henri Mondor University Hospital, AP-HP, Creteil, France
| | - Jean-Benoit Thambo
- Department of Pediatric and Congenital Cardiology, University Hospital of Bordeaux, Pessac, France
| | - Pascal Defaye
- Department of Rhythmology, University Hospital of Grenoble-Alpes, Grenoble, France
| | | | - Sélim Abbey
- Interventional Cardiology Unit, Hôpital Prive du Confluent, Nantes, France
| | - Didier Klug
- Department of Electrophysiology, Lille University Hospital, Lille, France
| | - Jean-Michel Juliard
- Département de Cardiologie, Hôpital Bichat, Université Paris-Diderot, Inserm U-1148, AP-HP, Paris, France
| | - Christian Spaulding
- Department of Cardiology, European Hospital Georges Pompidou, AP-HP, Paris Descartes University, INSERM U 970, Sudden Cardiac Death Expert Center, Paris, France
| | | | | | - Hamza Bhugaloo
- Inserm, CIC 1430, Henri Mondor University Hospital, Creteil, France
| | - Julien Ternacle
- Department of Cardiology, Henri Mondor University Hospital, AP-HP, Creteil, France
| | - Nicolas Lellouche
- Department of Cardiology, Henri Mondor University Hospital, AP-HP, Creteil, France
| | - Etienne Audureau
- Public Health Department, Hôpital Henri Mondor, Créteil, France.,U955-IMRB, Equipe CEpiA, Inserm, UPEC, Créteil, France
| | - Philippe Le Corvoisier
- Inserm, CIC 1430, Henri Mondor University Hospital, Creteil, France.,U955-IMRB, Equipe 03, Inserm, UPEC, Ecole Nationale Vétérinaire d'Alfort, Créteil, France
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Galea R, De Marco F, Aminian A, Meneveau N, Anselme F, Gräni C, Huber AT, Teiger E, Iriart X, Angelillis M, Brugger N, Spirito A, Corpataux N, Franzone A, Vranckx P, Fischer U, Pedrazzini G, Bedogni F, Windecker S, Räber L, Valgimigli M. Design and Rationale of the Swiss-Apero Randomized Clinical Trial: Comparison of Amplatzer Amulet vs Watchman Device in Patients Undergoing Left Atrial Appendage Closure. J Cardiovasc Transl Res 2021; 14:930-940. [PMID: 33884564 DOI: 10.1007/s12265-020-10095-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 12/16/2020] [Indexed: 12/29/2022]
Abstract
Residual or newly acquired leaks are routinely appraised after left atrial appendage closure (LAAC). The Watchman and the Amulet are the two most frequently used devices for LAAC but no randomized study has so far assessed their comparative leak rates after intervention. The "Comparison of Amplatzer Amulet vs Watchman devices in patients undergoing left atrial appendage closure" (Swiss-Apero, clinicaltrial.gov NCT03399851) is an academic-sponsored multicenter, randomized clinical trial comparing Amulet versus Watchman/FLX devices among patients undergoing a clinically indicated LAAC. The study is designed to assess the superiority of Amulet vs. Watchman/FLX in terms of leaks detected by cardiac computed tomography angiography (CCTA) at 45 days (primary endpoint) and 13 months (secondary endpoint) after intervention by an imaging Core Laboratory. The Swiss-Apero study is the first randomized clinical trial comparing Amulet and Watchman/FLX with respect to the prevalence of post-procedural leak as assessed with CCTA.
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Affiliation(s)
- Roberto Galea
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Federico De Marco
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Adel Aminian
- Department of Cardiology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
| | - Nicolas Meneveau
- Besancon University Hospital, EA3920, University of Burgundy Franche-Comté, Besancon, France
| | - Frederic Anselme
- Department of Cardiology, University Hospital of Rouen, Rouen, France
| | - Christoph Gräni
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Adrian T Huber
- Department of Diagnostic, Interventional and Pediatric Radiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Emmanuel Teiger
- Department of Cardiology, Henri-Mondor Hospital, Public Assistance Hospitals of Paris, Créteil, France
| | - Xavier Iriart
- Department of Pediatric and Adult Congenital Cardiology, Hôpital Cardiologique du Haut- Lévêque, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Marco Angelillis
- Cardiac Thoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Nicolas Brugger
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Alessandro Spirito
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Noé Corpataux
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anna Franzone
- Department of Advanced Biomedical Sciences, University Federico II University, Naples, Italy
| | - Pascal Vranckx
- Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis, Hasselt, Belgium.,Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Urs Fischer
- Department of Neurology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Giovanni Pedrazzini
- Cardiocentro Ticino, Via Tesserete 48, 6900, Lugano, Switzerland.,Department of Biomedical Sciences, University of Italian Switzerland, 6900, Lugano, Switzerland
| | - Francesco Bedogni
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marco Valgimigli
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland. .,Cardiocentro Ticino, Via Tesserete 48, 6900, Lugano, Switzerland.
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9
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Brockmeyer M, Wolff G, Krieger T, Lin Y, Karathanos A, Afzal S, Zeus T, Westenfeld R, Polzin A, Heinen Y, Perings S, Kelm M, Schulze V. Kidney function stratified outcomes of percutaneous left atrial appendage occlusion in patients with atrial fibrillation and high bleeding risk. Acta Cardiol 2020; 75:312-320. [PMID: 30983505 DOI: 10.1080/00015385.2019.1585643] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background: Patients with chronic kidney disease (CKD) and atrial fibrillation have increased risks for stroke and bleeding under oral anticoagulation (OAC). We investigated an alternative therapy of percutaneous left atrial appendage occlusion (LAAO) in CKD patients in this study.Methods: Consecutive patients undergoing LAAO were included in a retrospective analysis and stratified for kidney function into CKD/Non-CKD groups (cutoff eGFR 60 ml/min). Procedural characteristics, in-hospital and follow-up events were analysed and compared between groups.Results: LAAO was performed in 146 patients (81 CKD; 65 Non-CKD), mean follow-up was 391 days. Groups differed in eGFR (40.1 (CKD) vs. 75.1 (Non-CKD) ml/min) and CHA2DS2VASc scores (4.65 ± 1.3 (CKD) vs. 4.06 ± 1.4 (Non-CKD)). Procedural success was 98.6%, contrast-induced acute kidney injury was significantly more frequent in CKD patients (11.1% vs. 0%; p = .004). Follow-up mortality was higher in CKD (10.5/100 PY vs. 4.2/100 PY; p = .156). Follow-up stroke rates were 2.3/100 (CKD) patient-years (PY) and 1.4/100 PY (Non-CKD) (p = 1.000), corresponding to a relative risk reduction (RRR) of 60% (all), 68% (CKD) and 71% (Non-CKD) compared to expected stroke rates. Follow-up major bleeding rates were 3.5/100 PY (CKD) and 4.2/100 PY (Non-CKD), corresponding to RRR of 57% (all), 61% (CKD) and 53% (Non-CKD) compared to OAC.Conclusions: Left atrial appendage occlusion shows comparable efficacy for stroke and bleeding prevention in CKD and Non-CKD patients. CKD patients experience more adverse events during follow-up and a significantly increased risk for periprocedural contrast-induced acute kidney injury.
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Affiliation(s)
- Maximilian Brockmeyer
- Medical Faculty, Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf, Germany
| | - Georg Wolff
- Medical Faculty, Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf, Germany
| | - Torben Krieger
- Medical Faculty, Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf, Germany
| | - Yingfeng Lin
- Medical Faculty, Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf, Germany
| | - Athanasios Karathanos
- Medical Faculty, Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf, Germany
| | - Shazia Afzal
- Medical Faculty, Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf, Germany
| | - Tobias Zeus
- Medical Faculty, Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf, Germany
| | - Ralf Westenfeld
- Medical Faculty, Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf, Germany
| | - Amin Polzin
- Medical Faculty, Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf, Germany
| | - Yvonne Heinen
- Medical Faculty, Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf, Germany
| | - Stefan Perings
- Medical Faculty, Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf, Germany
| | - Malte Kelm
- Medical Faculty, Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf, Germany
- Medical Faculty, CARID – Cardiovascular Research Institute Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Volker Schulze
- Medical Faculty, Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf, Germany
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10
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Busu T, Khan SU, Alhajji M, Alqahtani F, Holmes DR, Alkhouli M. Observed versus Expected Ischemic and Bleeding Events Following Left Atrial Appendage Occlusion. Am J Cardiol 2020; 125:1644-1650. [PMID: 32273055 DOI: 10.1016/j.amjcard.2020.02.041] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/22/2020] [Accepted: 02/25/2020] [Indexed: 12/14/2022]
Abstract
Data on the efficacy of left atrial appendage occlusion (LAAO) in clinical practice are limited. We performed a systematic review and meta-analysis of observational studies that reported observed versus expected rates of ischemic strokes and/or major bleeding following LAAO. Our primary end points were the pooled relative risk reduction (RRR) in ischemic stroke and major bleeding with corresponding 95% confidence intervals compared with what was expected by the CHA2DS2-VASc and HASBLED scores, respectively. Twenty-nine studies including 11,071 patients (age 74.0 ± 8.7 years, 60% males) met the inclusion criteria. The mean CHA2DS2-VASc score was 4.22 ± 1.48, and the mean HASBLED score was 3.04 ± 1.16. During 19,567 patient-year follow-up, 290 of 11,071 patients (2.62%) suffered an acute ischemic stroke. This represented a 73.6% (95% confidence interval 68.9-78.2%) RRR in ischemic strokes compared with what was expected based on the CHA2DS2-VASc score. A total of 26 studies reported observed versus expected major bleeding (10,056 patients; age 74.0 ± 8.7, 60% males). During 16,967 patient-year follow-up, 404 of 10,056 patients (4.0%) suffered a major bleeding event. This represented a 55% (95% confidence interval 44.2% to -65.9%) RRR in major bleeding compared with what was expected based on the HASBLED score. These estimates were consistent across subgroups stratified according to age, CHADS2VASc, HASBLED scores and type of LAAO device used. In conclusion, LAAO is associated with a favorable observed/expected ratio with regards to ischemic stroke and major bleeding in clinical practice. Future clinical trials remain essential to further assess the efficacy of LAAO via a direct comparison with oral anticoagulation.
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11
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Bergmann MW. European registry data on LAA closure: advancing the field of interventional stroke prevention. EUROINTERVENTION 2019; 14:135-138. [PMID: 29937426 DOI: 10.4244/eijv14i2a20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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12
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Williams T, Alsanjari O, Parker J, Gannaway A, Thomson C, Gomes A, Hildick-Smith D. Day-case percutaneous left atrial appendage occlusion-Safety and efficacy. Catheter Cardiovasc Interv 2018; 92:1439-1443. [PMID: 30244516 DOI: 10.1002/ccd.27791] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 06/19/2018] [Accepted: 06/24/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVES We evaluated the safety and efficacy of percutaneous left atrial appendage (LAA) occlusion performed as a day case procedure. BACKGROUND LAA occlusion has been shown to be safe and effective for stroke prevention in patients with atrial fibrillation. It has not been shown if the procedure can safely be performed on a day-case basis. METHODS Retrospective analysis was made of 117 LAA occlusion procedures in a single large teaching hospital in the UK. Procedural success, procedural complications, length of stay, and readmission data were examined. RESULTS Successful deployment of a device was possible in all but one patient (whose appendage was too large). Major in-hospital complications occurred in 1.7% of patients (both femoral vascular). Same-day discharge was made in 66% of patients overall. Since January 2016, only 3 of 59 patients (5%) have remained in hospital overnight following LAAO. Echocardiography 2-4 hr postprocedure was undertaken prior to discharge. One patient was readmitted within 7 days but this readmission would not have been prevented by overnight stay. CONCLUSIONS LAA occlusion can be safely performed as a day case procedure with acceptable complication rates and no increment of complications related to the lack of routine overnight stay.
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Affiliation(s)
- Timothy Williams
- Department of Cardiology, Sussex Cardiac Centre, Brighton and Sussex University Hospitals, United Kingdom
| | - Osama Alsanjari
- Department of Cardiology, Sussex Cardiac Centre, Brighton and Sussex University Hospitals, United Kingdom
| | - Jessica Parker
- Department of Cardiology, Sussex Cardiac Centre, Brighton and Sussex University Hospitals, United Kingdom
| | - Alex Gannaway
- Department of Cardiology, Sussex Cardiac Centre, Brighton and Sussex University Hospitals, United Kingdom
| | - Catherine Thomson
- Department of Cardiology, Sussex Cardiac Centre, Brighton and Sussex University Hospitals, United Kingdom
| | - Arionilson Gomes
- Department of Cardiology, Sussex Cardiac Centre, Brighton and Sussex University Hospitals, United Kingdom
| | - David Hildick-Smith
- Department of Cardiology, Sussex Cardiac Centre, Brighton and Sussex University Hospitals, United Kingdom
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13
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Segers VF, Heidbuchel H. Evidencia e indicaciones del cierre percutáneo de la orejuela izquierda. Rev Esp Cardiol 2018. [DOI: 10.1016/j.recesp.2018.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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14
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Segers VFM, Heidbuchel H. Evidence and Indications for Percutaneous Closure of the Left Atrial Appendage. ACTA ACUST UNITED AC 2018; 71:700-702. [PMID: 29653775 DOI: 10.1016/j.rec.2018.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 03/09/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Vincent F M Segers
- Department of Cardiology, University Hospital Antwerp, Edegem, Belgium; Laboratory of Physiopharmacology, University of Antwerp, Antwerp, Belgium
| | - Hein Heidbuchel
- Department of Cardiology, University Hospital Antwerp, Edegem, Belgium; Cardiovascular Research Group, University of Antwerp, Antwerp, Belgium.
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