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Safety and feasibility of peri-device leakage closure after LAAO: an international, multicentre collaborative study

2021; European Association of Percutaneous Cardiovascular Interventions; Volume: 17; Issue: 12 Linguagem: Inglês

10.4244/eij-d-21-00286

1969-6213

Kerstin Piayda, Kolja Sievert, Domenico G. Della Rocca, Oluwaseun Adeola, Mohamad Alkhouli, David Yoo, Tomas Benito‐González, Ignacio Cruz‐González, Roberto Galea, Carsten Skurk, Ole De Backer, Jens Erik Nielsen‐Kudsk, Marek Grygier, Elijah Beaty, Jim Newton, Armando Pérez de Prado, Lorenz Räber, Douglas Gibson, Christoffel J. van Niekerk, Christopher R. Ellis, Rodney Horton, Andrea Natale, Iris Grundwald, Tobias Zeus, Horst Sievert,

Cardiac Imaging and Diagnostics

Residual peri-device leakage (PDL) is frequent after left atrial appendage occlusion (LAAO). Little is known about management strategies, procedural aspects and outcomes of interventional PDL closure.The aim of this study was to assess the safety and feasibility of PDL closure after LAAO.Fifteen centres contributed data on baseline characteristics, in-hospital and follow-up outcomes of patients who underwent PDL closure after LAAO. Outcomes of interest included acute success and complication rates and long-term efficacy of the procedure.A total of 95 patients were included and a cumulative number of 104 leaks were closed. The majority of PDLs were detected within 90 days (range 41-231). Detachable coils were the most frequent approach (42.3%), followed by the use of the AMPLATZER Vascular Plug II (29.8%) and the AMPLATZER Duct Occluder II (17.3%). Technical success was 100% with 94.2% of devices placed successfully within the first attempt. There were no major complications requiring surgical or transcatheter interventions. During follow-up (96 days [range 49-526]), persistent leaks were found in 18 patients (18.9%), yielding a functional success rate of 82.7%, although PDLs were significantly reduced in size (pre-leak sizemax: 6.1±3.6 mm vs post-leak sizemax: 2.5±1.3 mm, p 5 mm. Major adverse events during follow-up occurred in 5 patients (2 ischaemic strokes, 2 intracranial haemorrhages, and 1 major gastrointestinal bleeding).Several interventional techniques have become available to achieve PDL closure. They are associated with high technical and functional success and low complication rates.