SPC365

Left atrial appendage occlusion is an effective and safe strategy for long term prevention of stroke or systemic embolism

Session: Posters (Sessão 4 - Écran 7) - Intervenção Cardíaca Coronária e Estrutural 2 - Foco na Doença Estrutural Não Valvular
Speaker: Catarina Oliveira

Congress: CPC 2022
Topic: H. Interventional Cardiology and Cardiovascular Surgery
Theme: 25. Interventional Cardiology
Subtheme: 25.3 Non-coronary Cardiac Intervention
Session Type: Pósters Electrónicos
FP Number: ---
Authors: Catarina Simões de Oliveira; Sara Couto Pereira; Pedro Silvério António; Joana Brito; Pedro Alves da Silva; Beatriz Valente Silva; Ana Beatriz Garcia; Ana Margarida Martins; Miguel Azaredo Raposo; Ana Abrantes; Ana Rita Francisco; João Silva Marques; Miguel Nobre Menezes; Fausto j. Pinto; Pedro Cardoso

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: Oral anticoagulation (OAC), with either vitamin K antagonists or direct oral anticoagulant agents, has been the mainstay for cardioembolic stroke prevention in atrial fibrillation. Since left atrial appendage (LAA) is the major source of embolism in these patients (pts), mechanical approaches in this setting have been developed, with particular relevance for those with contraindications to OAC or with recurrent events.&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Objective</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: To describe LAA occlusion (LAAO) safety and effectiveness, using a single center registry during a 12-year period.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: Single center registry of 139 pts submitted to LAAO during a 12-year period. We gathered clinical characteristics, CHADsVASc and HASBLED score, procedure characteristics, complications and ACO therapy.&nbsp; Efficacy endpoint was defined as stroke or embolic event. Safety endpoint was major bleeding according to HAS-BLED criteria. Results were assessed by plotting actual events versus expected events according to the risk scores, using Kaplan-Meier curves for analysis.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: 139 pts underwent LAAO. 130 Watchman&reg; devices were implanted (22 were WatchmanFlex&reg;). Remaining devices were 5 ACP Amulet&reg; and 4 Cardiac Plug&reg;. Majority (60.4%) of pts were male, mean age of 74&plusmn;8 years. Regarding procedural complications, there were 3 cases of cardiac tamponade in the early stages of the program, all successfully resolved with percutaneous pericardiocentesis. During a mean follow-up period of 4.1&plusmn;2.8 years, 4 strokes and 1 additional embolic event (mesenteric ischemia) occurred. There were 58 deaths, 3 from cardiovascular causes. Mean CHA2Ds2VASc score was 4.2&plusmn;1.3, which would theoretically correspond to 41 embolic events (25 strokes) during follow-up. Therefore, a statistically significant reduction in events (5 vs 41, Log Rank 25.006, p&lt;0.001) was registered, with a relative risk reduction (RRR) of 88%, which is at least not inferior to the expected effect of OAC. As for hemorrhagic risk, 20 hemorrhagic events (6 major bleeding) were registered. Mean HAS-BLED score was 3.4&plusmn;0.9, which would correspond to 37 major bleeding events. Once again, a statistically significant reduction in events (37vs6, LogRank 19.728, p&lt;0.001), after LAAO, was noted in our study (85%RRR).&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusion</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: LAAO was a safe procedure, with major positive impact in embolic risk reduction, sustained over a long follow-up period. A great number of expected hemorrhagic events were averted by avoiding OAC in selected pts at high risk of bleeding.</span></span></span></p>

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