Impact of Echocardiographic Guidance on Safety and Efficacy of Left Atrial Appendage Closure: An Observational Study.

Galea, Roberto; Räber, Lorenz; Fuerholz, Monika; Häner, Jonas D; Siontis, George C M; Brugger, Nicolas; Moschovitis, Aris; Heg, Dik; Fischer, Urs; Meier, Bernhard; Windecker, Stephan; Valgimigli, Marco (2021). Impact of Echocardiographic Guidance on Safety and Efficacy of Left Atrial Appendage Closure: An Observational Study. JACC. Cardiovascular Interventions, 14(16), pp. 1815-1826. Elsevier 10.1016/j.jcin.2021.05.042

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OBJECTIVES

The aim of this study was to evaluate the impact of echocardiographic guidance on the safety and efficacy of left atrial appendage closure (LAAC).

BACKGROUND

Expert consensus documents recommend intraprocedural imaging by means of either transesophageal echocardiography or intracardiac echocardiography to guide LAAC. However, no evidence exists that intraprocedural echocardiographic guidance in addition to fluoroscopy improves the safety and efficacy of LAAC.

METHODS

Consecutive LAAC procedures performed at a high-volume center between January 2009 and October 2020 were stratified on the basis of intraprocedural imaging modalities, including fluoroscopic guidance (FG) only or intraprocedural echocardiographic guidance (EG) in addition to fluoroscopy. The primary safety endpoint was the composite of procedure-related complications occurring within 7 days after the procedure. Technical success at 7 days and at follow-up were secondary endpoints.

RESULTS

Among 811 LAAC procedures, 549 (67.7%) and 262 (32.3%) were assigned to the FG and EG groups, respectively. After adjusting for confounders, EG remained associated with a lower rate of the primary safety endpoint (3.4% vs 9.1%; P = 0.004; adjusted odds ratio [OR]: 0.31; 95% CI: 0.11-0.90; P = 0.030). Technical success trended higher at 7 days (92.1% vs 87.2%; P = 0.065; adjusted OR: 1.68; 95% CI: 0.95-3.01; P = 0.079) and was significantly improved with EG compared with FG (87.6% vs 79.9%; P = 0.018; OR: 4.06; 95% CI: 1.60-10.27; P = 0.003) after a median follow-up period of 4.9 months (interquartile range: 3.4 months-6.2 months).

CONCLUSIONS

In a large cohort of consecutive LAACs, the use of intraprocedural echocardiography to guide intervention in addition to standard fluoroscopy was associated with lower risks for procedural complications and higher mid-term technical success rates.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
04 Faculty of Medicine > Pre-clinic Human Medicine > CTU Bern

UniBE Contributor:

Galea, Roberto; Räber, Lorenz; Fürholz, Monika; Häner, Jonas; Siontis, Georgios; Brugger, Nicolas Jacques; Heg, Dierik Hans; Fischer, Urs; Meier, Bernhard; Windecker, Stephan and Valgimigli, Marco

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1876-7605

Publisher:

Elsevier

Funders:

[116] Swiss Heart Foundation = Schweizerische Herzstiftung

Language:

English

Submitter:

Doris Kopp Heim

Date Deposited:

30 Aug 2021 14:57

Last Modified:

07 Sep 2021 19:37

Publisher DOI:

10.1016/j.jcin.2021.05.042

PubMed ID:

34412799

Uncontrolled Keywords:

left atrial appendage closure procedural safety procedure guidance technical success transesophageal echocardiography

BORIS DOI:

10.48350/159074

URI:

https://boris.unibe.ch/id/eprint/159074

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