Wolfrum, Mathias; Attinger-Toller, Adrian; Shakir, Samera; Glökler, Steffen; Seifert, Burkhardt; Moschovitis, Aris; Khattab, Ahmed Aziz; Maisano, Francesco; Meier, Bernhard; Nietlispach, Fabian (2016). Percutaneous left atrial appendage occlusion: Effect of device positioning on outcome. Catheterization and cardiovascular interventions, 88(4), pp. 656-664. Wiley-Blackwell 10.1002/ccd.26646
Full text not available from this repository. (Request a copy)OBJECTIVE
The study in patients with percutaneous left atrial appendage (LAA) occlusion investigates clinical outcomes according to the position of the Amplatzer Cardiac Plug (ACP) disc.
BACKGROUND
The ACP consists of a disc and an anchoring lobe. The disc is meant to cover the ostium of the LAA, but frequently retracts partially or completely into the neck of the LAA. It is not known whether a retracted disc affects outcome.
METHODS
Outcomes of 169 consecutive patients (age 73.1 ± 10.4 years; 76% male) with successful LAA closure were analyzed according to the position of the ACP disc: group A had complete coverage of the LAA ostium; in group B the disc prolapsed partially or completely into the LAA-neck. Transesophageal echocardiography was performed 1-6 months after ACP implantation. The safety endpoint was the composite of clinically significant pericardial effusion, device embolization, procedure-related stroke/transient ischemic attack (TIA), major bleeding, or device thrombus. The efficacy endpoint was the composite of death, neurological events (ischemic and hemorrhagic stroke, TIA), or systemic embolism during follow-up.
RESULTS
Group A comprised 76 patients (age 73.0 ± 9.9 years; 74% male) and group B 93 patients (age 73.3 ± 10.9 years; 79% male). Mean CHA2 DS2 -Vasc score and HASBLED score were 4.2 ± 1.7 (group A 4.3 ± 1.6; group B 4.2 ± 1.8) and 2.9 ± 1.1 (group A 2.9 ± 1.0; group B 3.0 ± 1.2), respectively. Mean follow-up of the study population was 13.0 ± 10.4 months. Overall, the composite safety and efficacy endpoints occurred in 20 (12%) and 6 patients (4%), respectively. There was no significant difference between groups A and B in the occurrence of the safety endpoint (13% vs. 11%, P = 0.64), or the efficacy endpoint (4% vs. 3%, P = 1.0).
CONCLUSIONS
No evidence for a difference in the occurrence of the safety and efficacy endpoint was found between patients with complete vs. incomplete ACP disc coverage of the LAA ostium. The risk of repositioning attempts in case of incomplete coverage does not seem to be warranted. Current findings need further confirmation in a larger scale clinical trial. © 2016 Wiley Periodicals, Inc.
Item Type: |
Journal Article (Original Article) |
|---|---|
Division/Institute: |
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology |
UniBE Contributor: |
Glökler, Steffen, Moschovitis, Aris, Khattab, Ahmed Aziz, Meier, Bernhard |
Subjects: |
600 Technology > 610 Medicine & health |
ISSN: |
1522-1946 |
Publisher: |
Wiley-Blackwell |
Language: |
English |
Submitter: |
Daria Vogelsang |
Date Deposited: |
08 Mar 2017 16:41 |
Last Modified: |
05 Dec 2022 15:01 |
Publisher DOI: |
10.1002/ccd.26646 |
PubMed ID: |
27465268 |
Uncontrolled Keywords: |
bleeding; left atrial appendage closure; outcome; stroke |
URI: |
https://boris.unibe.ch/id/eprint/92566 |
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