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Left atrial appendage closure: does shape matter?
Session:
Sessão de Posters 01 - Intervenção não valvular
Speaker:
Mariana Rodrigues Simões
Congress:
CPC 2024
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.3 Non-coronary Cardiac Intervention
Session Type:
Cartazes
FP Number:
---
Authors:
Mariana Rodrigues Simões; Rafaela Fernandes; Gonçalo Ferraz Costa; Ana L. Silva; Tatiana Pereira Dos Santos; Gonçalo Terleira Batista; Diogo Fernandes; Manuel Santos; José Luis Martins; Luis Paiva; Marco Costa; Lino Gonçalves
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><u>Introduction</u>: The left atrial appendage (LAA) is known for its thrombogenic features. It has a variety of shapes whose impact on procedures’ results remains uncertain. </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><u>Methods</u>: We conducted a retrospective study at one centre, reviewing all patients who underwent catheter based LAA closure between May 2010 and December 2020. Using SPSS software, we compare periprocedural results and outcomes by the end of follow-up in patients who had a specific LAA morphology: cactus. </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><u>Results</u>: Across ten years, 156 patients underwent LAA closure, with an average follow-up of 898 (±844) days. LAA morphology was described in 93 patients. Morphologically, there were 40 windsock, 18 cauliflower, 23 chicken wing, 9 cactus and 3 LAA with other shapes. The patients were split into two groups based on their LAA morphology: the cactus (C) group and the non-cactus (NC) group. The median age in the C group was 77 (ID=10), while in the NC group, it was 75 (ID=11), (p=0.896). About 44,4% of patients in the C group were men compared to 66,6% in the NC group (p=0.272). There were no differences in cardioembolic and hemorrhagic risk between the two groups, with similar median CHA<sub>2</sub>DS<sub>2</sub>VASC (4, p=0.464) and HASBLED (3, p=0.315) scores. All nine patients with the cactus morphology underwent successful LAA closure but one required a second attempt. Fluoroscopy time (in minutes) during procedure (C group: 30.30 (10.3) vs NC group: 23 (9.6), p=0.439) and contrast doses (in milliliters) (C group: 120 (148) vs NC group: 104.5 (73), p=0.194) were the same. In terms of in-hospital major cardiovascular adverse events, the C group showed a higher percentage of events 22,2% (2 cardiac tamponade) versus 3.5% (2 cardiac tamponade and 1 major bleeding), (p=0.072). During follow-up, the cactus group had a higher percentage of cardiovascular adverse events: 1 stroke, 1 myocardial infarction and 1 cardiogenic shock (n=3; 33.3%) compared to the NC group: 4 strokes and 1 cardiogenic shock (n=5; 6,76%), showing a significant difference (p=0.038, OR: 6,90(1.32-36.17)). Additionally, 56% of patients (n=5) in C group died during follow up period, significantly higher than the 18% (n=13) in the NC group (p=0.021; OR:5,77 (1.37-24,47)). There were no differences observed between cardiovascular and non-cardiovascular deaths between groups (p=0.095 and p=0.103, respectively).</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><u>Conclusion</u>: Patients presenting cactus morphology seem to be at a higher risk of in-hospital major cardiovascular adverse events. Besides, c</span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">actus LAA morphology was associated with more occurrences of cardiovascular adverse events and all-cause death during follow-up time. </span></span></span></p>
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