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Percutaneous left atrial appendage closure: a 10-year experience
Session:
Painel 11 - Cardiologia Intervenção 3
Speaker:
André Grazina
Congress:
CPC 2020
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.3 Non-coronary Cardiac Intervention
Session Type:
Posters
FP Number:
---
Authors:
André Grazina; André Viveiros Monteiro; António Fiarresga; Ruben Ramos; Luisa Moura Branco; Lidia De Sousa; Duarte Cacela; José Miguel Viegas; Pedro Garcia Brás; Vera Ferreira; Alexandra Castelo; Rui Cruz Ferreira
Abstract
<p><strong>Introduction:</strong> Oral anticoagulants are the standard treatment for prevention of stroke in patients with atrial fibrillation (AF). However, some patients still have stroke despite therapeutic anticoagulation and/or have contraindications to anticoagulation. The left atrial appendage closure (LAA closure) is an option for those patients.</p> <p><strong>Objectives:</strong> This study aims to evaluate the safety and efficacy of LAA closure in the 10-year experience of our center.</p> <p><strong>Methods:</strong> Between 2009 and 2019, a total of 80 patients (75,5±10,3 years, 66,3% men, with a CHA2DS2-VASc score ≥2) underwent percutaneous LAA closure. Stroke risk assessment was performed with CHA2DS2-VASc and the bleeding risk with HAS-BLED. Mortality, embolic and bleeding events were accessed retrospectively.</p> <p><strong>Results:</strong> Permanent AF was present in 71,3% and paroxystic in 28,7%. History of major bleeding was the most common reason for LAA closure (65%, n=52) followed by high bleeding risk (17,5%, n=14), ischemic events under therapeutic anticoagulation (11,3%, n=9) and labile INR (3,3%, n=3). The average CHA2DS2-VASc and HAS-BLED were 4,1±1,4 and 3.6±1.1, respectively. Successful implantation was achieved in 92,5% (n=74). In the hospitalization period, there was 1 death (1,3%) related to the procedure (a LAA closure device embolization to left ventricle, with resultant cardiac arrest). The registered complications were thrombus formation in the device without embolization in 3,8%, femoral pseudoaneurysms in 3,8%, inguinal bleeding in 2,5%, other site bleedings in 5,0%, transient ischemic accident (TIA) in 2,5%, stroke in 1,3%, right coronary artery gas embolization in 1,3% and cardiac tamponade in 1,3%. The average follow-up duration was 22 months, with an all cause mortality of 13,8% (n=11). Hospital readmissions were reported in 41,3% of the patients (n=33) and in 6,1% (n=2) of those the readmissions were related with elective surgical LAA closure. Ischemic stroke (excluding TIA) occurred in 4 patients and major bleeding in 10 patients, resulting in an annual stroke rate of 2,8% and annual bleeding rate of 7,0%. These rates are inferior than predicted from the standard risk scores (4% strokes/year based on CHA2DS2-VASc and 8.7% major bleeding/year based on HAS-BLED).</p> <p><strong>Conclusions:</strong> This data support the effectiveness and safety of the percutaneous LAA closure in stroke prevention in patients with AF and formal contraindication to oral anticoagulation or whom developed embolic events under anticoagulation.</p>
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