SPC365

Left Atrial Appendage Occlusion: results of a large long-term cohort

Session: SESSÃO DE POSTERS 53 - FIBRILHAÇÃO AURICULAR E ARRITMIAS AURICULARES COMPLEXAS
Speaker: Joao Santos Fonseca

Congress: CPC 2025
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Session Type: Cartazes
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Authors: Joao Santos Fonseca; Miguel Nobre Menezes; Catarina Gregório; Miguel Azaredo Raposo; Ana Rita Francisco; Catarina Oliveira; Tiago Rodrigues; João Silva Marques; Gustavo Silva; João de Sousa; Pedro Cardoso; Fausto J. Pinto
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><strong><span style="font-family:&quot;Calibri&quot;,sans-serif">Introduction</span></strong><span style="font-family:&quot;Calibri&quot;,sans-serif">: Left atrial appendage occlusion (LAAO) is increasingly used as an alternative to prevent stroke in patients (pts) with atrial fibrillation (AF), particularly those with trombo-embolic events despite oral anticoagulation (OAC) or OAC intolerance. </span></span></span></p>

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<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><strong><span style="font-family:&quot;Calibri&quot;,sans-serif">Aim</span></strong><span style="font-family:&quot;Calibri&quot;,sans-serif">: To evaluate the efficacy and safety of LAAO in pts with AF.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><strong><span style="font-family:&quot;Calibri&quot;,sans-serif">Methods</span></strong><span style="font-family:&quot;Calibri&quot;,sans-serif">: Single-center retrospective study of consecutive pts who underwent percutaneous LAAO between November 2009 and December 2024. Comorbidity burden and thromboembolic risk were assessed using the Charlson Comorbidity Index (CCI) and CHA2DS2-VASc score. Efficacy was defined by the absence of stroke, cardiovascular death, or systemic embolic events. The composite safety endpoint included procedural complications and major bleeding events. Statistical analyses used Student&rsquo;s t-test for continuous variables and chi-square tests for categorical variables.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><strong><span style="font-family:&quot;Calibri&quot;,sans-serif">Results</span></strong><span style="font-family:&quot;Calibri&quot;,sans-serif">: A total of 215 pts were included (mean age of 74.5 &plusmn; 8.1 years, 64% male, 41% had paroxysmal AF); of these, 22% had CKD stage 3 or higher, and 20% had a history of cancer (9% gastrointestinal). The mean CCI was 5.7 &plusmn; 0.1. The mean CHA2DS2-VASc score was 4.1 &plusmn; 0.1, and one-third of the pts had a history of stroke. The annual bleeding risk was 6.1 &plusmn; 0.5% (mean HAS-BLED score 3.1 &plusmn;&nbsp;0.1). The main reasons for referring pts for LAAO were previous gastrointestinal bleeding (37%), hemorrhagic stroke (19%), and ischemic stroke despite anticoagulation (9%).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="font-family:&quot;Calibri&quot;,sans-serif">The procedure was successful in 96% of cases, with a mean duration of 89.7 &plusmn; 12 min. In 95% of cases, a Watchman device was implanted (42% were Watchman FLX, device size 27 &plusmn; 2 mm). The procedure was guided by intracardiac echocardiography in 28% of cases and transesophageal echocardiography in the remaining cases. Post-procedural antithrombotic therapy was administered as follows: 43% received dual antiplatelet therapy, 26% were treated with VKA and aspirin, 18% with NOACs, and the remaining with single antiplatelet therapy, for an average duration of 6.1 months.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="font-family:&quot;Calibri&quot;,sans-serif">Acute procedural complications included 4 cases of pericardial tamponade and 4 vascular access complications (1 major). All major complications occurred up early 2015.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="font-family:&quot;Calibri&quot;,sans-serif">During follow-up, 31 pts experienced bleeding events, of which&nbsp;3 were classified as major (2 gastrointestinal, 1 genitourinary) according to the VARC-3 definition. The primary safety endpoint occurred in 38 pts. During a mean follow-up of 44.7 &plusmn; 3.3 months, there were 7 strokes and 1 thrombotic event. The primary efficacy endpoint was observed in 13 pts. Based on the CHA2DS2-VASc score, the expected stroke/systemic embolism rate in our population was 6.7%, but during follow-up, the observed event rate was only 0.09%, representing an 86% relative risk reduction.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><strong><span style="font-family:&quot;Calibri&quot;,sans-serif">Conclusion</span></strong><span style="font-family:&quot;Calibri&quot;,sans-serif">: LAAO demonstrated high procedural success and a favorable safety profile, effectively reducing thromboembolic events in a high-risk population over long-term follow-up.</span></span></span></p>