Amplatzer left atrial appendage closure: access via transseptal puncture versus patent foramen ovale or atrial septal defect.

Kleinecke, Caroline; Fuerholz, Monika; Buffle, Eric; de Marchi, Stefano; Schnupp, Steffen; Brachmann, Johannes; Nietlispach, Fabian; Fankhauser, Mate; Streit, Samuel R; Windecker, Stephan; Meier, Bernhard; Gloekler, Steffen (2020). Amplatzer left atrial appendage closure: access via transseptal puncture versus patent foramen ovale or atrial septal defect. EuroIntervention, 16(2), e173-e180. Europa Digital & Publishing 10.4244/EIJ-D-19-00442

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AIMS To compare periprocedural and late clinical outcomes of left atrial appendage closure (LAAC) with Amplatzer devices by access through transseptal puncture (TSP) versus a patent foramen ovale (PFO) or an atrial septal defect (ASD). METHODS AND RESULTS Between 2009 and 2018, 578 consecutive patients underwent LAAC via TSP or PFO/ASD access in three centers. After a 1:3 propensity score matching, 246 (TSP) vs 246 (PFO/ASD) patients were compared by use of the primary efficacy endpoint of all-cause stroke, systemic embolism and cardiovascular/unexplained death and the primary safety endpoint of major peri-procedural complications and major bleedings at follow-up. Mean age was 75.2±8.7 (TSP) vs 74.4±10.9 (PFO/ASD) years, CHA2DS2-VASc score 4.5±1.6 vs 4.3±1.4, and HAS-BLED score 3.3±1.0 vs 3.3±0.9. Device success (97.6% vs 97.8%, p=0.90) was similar. After 2.5±1.4 vs 2.6±1.6 years, clinical efficacy (46/603, 7.6% [TSP] vs 21/233, 9.0% [PFO/ASD], 10.3, hazard ratio (HR), 1.2; 95% confidence interval (CI), 0.69-0.85, p=0.54) and safety (24/603, 4.0% vs 11/233, 4.7%; HR, 1.4; 95% CI, 0.52-3.6, p=0.49) did not differ. CONCLUSIONS Use of a PFO/ASD access for LAAC with Amplatzer devices offers similar periprocedural and late clinical outcomes as TSP. Simultaneous PFO/ASD closure for an additional protective benefit does not increase risk.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Fürholz, Monika; Buffle, Eric Jacques; De Marchi, Stefano and Windecker, Stephan

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1774-024X

Publisher:

Europa Digital & Publishing

Language:

English

Submitter:

Nadia Biscozzo

Date Deposited:

10 Feb 2020 15:00

Last Modified:

18 Jun 2020 01:31

Publisher DOI:

10.4244/EIJ-D-19-00442

PubMed ID:

31449043

BORIS DOI:

10.7892/boris.139090

URI:

https://boris.unibe.ch/id/eprint/139090

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