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

TY - JOUR

T1 - Safety and feasibility of peri-device leakage closure after LAAO

T2 - an international, multicentre collaborative study

AU - Piayda, Kerstin

AU - Sievert, Kolja

AU - Rocca, Domenico G.Della

AU - Adeola, Oluwaseun G.

AU - Alkhouli, Mohamad

AU - Yoo, David

AU - Benito-González, Tomás

AU - González, Ignacio Cruz

AU - Galea, Roberto

AU - Skurk, Carsten

AU - de Backer, Ole

AU - Nielsen-Kudsk, Jens Erik

AU - Grygier, Marek

AU - Beaty, Elijah H.

AU - Newton, Jim

AU - de Prado, Armando Pérez

AU - Räber, Lorenz

AU - Gibson, Douglas

AU - Van Niekerk, Christoffel

AU - Ellis, Christopher R.

AU - Horton, Rodney P.

AU - Natale, Andrea

AU - Grunwald, Iris

AU - Zeus, Tobias

AU - Sievert, Horst

N1 - Publisher Copyright: © Europa Digital & Publishing 2021.

PY - 2021/12

Y1 - 2021/12

N2 - Background: Residual peri-device leakage (PDL) is frequent after left atrial appendage occlusion (LAAO). Little is known about management strategies, procedural aspects and outcomes of interventional PDL closure. Aims: The aim of this study was to assess the safety and feasibility of PDL closure after LAAO. Methods: Fifteen centres contributed data on baseline characteristics, in-hospital and follow-up outcomes of patients who underwent PDL closure after LAAO. Outcomes of interest included acute success and complication rates and long-term efficacy of the procedure. Results: A total of 95 patients were included and a cumulative number of 104 leaks were closed. The majority of PDLs were detected within 90 days (range 41-231). Detachable coils were the most frequent approach (42.3%), followed by the use of the AMPLATZER Vascular Plug II (29.8%) and the AMPLATZER Duct Occluder II (17.3%). Technical success was 100% with 94.2% of devices placed successfully within the first attempt. There were no major complications requiring surgical or transcatheter interventions. During follow-up (96 days [range 49-526]), persistent leaks were found in 18 patients (18.9%), yielding a functional success rate of 82.7%, although PDLs were significantly reduced in size (pre-leak sizemax: 6.1±3.6 mm vs post-leak sizemax: 2.5±1.3 mm, p<0.001). None of the patients had a leak >5 mm. Major adverse events during follow-up occurred in 5 patients (2 ischaemic strokes, 2 intracranial haemorrhages, and 1 major gastrointestinal bleeding). Conclusions: Several interventional techniques have become available to achieve PDL closure. They are associated with high technical and functional success and low complication rates.

AB - Background: Residual peri-device leakage (PDL) is frequent after left atrial appendage occlusion (LAAO). Little is known about management strategies, procedural aspects and outcomes of interventional PDL closure. Aims: The aim of this study was to assess the safety and feasibility of PDL closure after LAAO. Methods: Fifteen centres contributed data on baseline characteristics, in-hospital and follow-up outcomes of patients who underwent PDL closure after LAAO. Outcomes of interest included acute success and complication rates and long-term efficacy of the procedure. Results: A total of 95 patients were included and a cumulative number of 104 leaks were closed. The majority of PDLs were detected within 90 days (range 41-231). Detachable coils were the most frequent approach (42.3%), followed by the use of the AMPLATZER Vascular Plug II (29.8%) and the AMPLATZER Duct Occluder II (17.3%). Technical success was 100% with 94.2% of devices placed successfully within the first attempt. There were no major complications requiring surgical or transcatheter interventions. During follow-up (96 days [range 49-526]), persistent leaks were found in 18 patients (18.9%), yielding a functional success rate of 82.7%, although PDLs were significantly reduced in size (pre-leak sizemax: 6.1±3.6 mm vs post-leak sizemax: 2.5±1.3 mm, p<0.001). None of the patients had a leak >5 mm. Major adverse events during follow-up occurred in 5 patients (2 ischaemic strokes, 2 intracranial haemorrhages, and 1 major gastrointestinal bleeding). Conclusions: Several interventional techniques have become available to achieve PDL closure. They are associated with high technical and functional success and low complication rates.

KW - Atrial fibrillation

KW - LAA closure

KW - Stroke

UR - https://www.scopus.com/pages/publications/85122073326

U2 - 10.4244/EIJ-D-21-00286

DO - 10.4244/EIJ-D-21-00286

M3 - Article

C2 - 34219662

AN - SCOPUS:85122073326

SN - 1774-024X

VL - 17

SP - E1033-E1040

JO - EuroIntervention

JF - EuroIntervention

IS - 12

ER -