SPC365

Percutaneous left atrial appendage closure: a single center experience

Session: Comunicações Orais (Sessão 9) - Intervenção Cardíaca Coronária e Estrutural 2 - Vários Tópicos
Speaker: Ana Rita Gomes

Congress: CPC 2022
Topic: H. Interventional Cardiology and Cardiovascular Surgery
Theme: 25. Interventional Cardiology
Subtheme: 25.3 Non-coronary Cardiac Intervention
Session Type: Comunicações Orais
FP Number: ---
Authors: Ana Rita m. Gomes; Carolina Saleiro; Natália António; Manuel Oliveira-Santos; Luís Paiva; Marco Costa; Lino Gonçalves

<p style="text-align:justify"><span style="color:#000000"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Background</span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">: In patients with atrial fibrillation and high thromboembolic risk, percutaneous closure of left atrial appendage (LAA) is an alternative treatment in case of contraindication to oral anticoagulants (OAC) or an additional strategy for therapeutic failure.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="color:#000000"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Aim</span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">: This study aims to assess the feasibility and efficacy of LAA percutaneous closure in the prevention of thromboembolic events.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="color:#000000"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Methods</span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">: Retrospective analysis of patients consecutively admitted for percutaneous LAA closure in a single Cardiology Department between May 2010 and December 2021. The procedure was guided by transesophageal echocardiogram (TEE) or intracardiac echocardiography (ICE) and device options included first generation Amplatzer Cardiac Plug (ACP), second generation ACP (Amulet) and Watchmann. A short-term follow-up was conducted with echocardiographic control at 1 month.&nbsp;Long-term follow-up included screening for thromboembolic and hemorrhagic events.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="color:#000000"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Results</span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">: A total of 179 patients were included. The median age was 75 (68-80) years old, 65.4% were male and 30.2% had paroxysmal atrial fibrillation. About a third&nbsp;(36.3%) had previous history of stroke or transitory ischemic attack and 14.0% had coronary artery disease. The prevalence of arterial hypertension was 82.1%, 59.2% had dyslipidemia, 35.8% had diabetes mellitus and 30.2% chronic kidney disease. The mean CHA<sub>2</sub>DS<sub>2</sub>-VASc risk score was 4.3&plusmn;1.5 and mean HAS-BLED score was 3.1&plusmn;1.1 (&ge;3 in 72.7%). The main indications for LAA closure were previous major hemorrhage (57.0%), high bleeding risk (23.5%), embolic events while on OAC therapy (13.4%) or recurrent minor bleeding (12.8%). The procedural success rate was 95.5%. It was guided by TEE (59.8%) and/or ICE (46.9%). The most used device was Amulet (68.0%), followed by ACP (18.3%) and Watchmann (13.7%). Median follow-up time was 12.0 (5.0-21.0) months. In long-term follow-up, we registered a mortality rate of 10.1%, being 22.2% due to cardiovascular causes. Thromboembolic and bleeding events incidence was lower than expected from CHA<sub>2</sub>DS<sub>2</sub>-VASc (expected stroke&nbsp;rate/year 5.6% vs observed stroke rate/year 0.4%; 92.5% risk reduction) and HAS-BLED (expected major bleeding rate/year 4.7% vs observed major bleeding rate/year 2.9%; 37.7% risk reduction) scores, respectively.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="color:#000000"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Conclusion</span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">: According to our study, percutaneous left atrial appendage closure is feasible and seems to offer significant protection against thromboembolic and hemorrhagic events in high-risk patients.</span></span></span></span></span></p>