The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

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

DOI: 10.4244/EIJ-D-19-00442

1. Department of Cardiology, Klinikum Lichtenfels, Lichtenfels, Germany
2. Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland
3. Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland
4. Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland
5. Department of Cardiology, Klinikum Coburg, Coburg, Germany
6. Department of Cardiology, Klinikum Coburg, Coburg, Germany
7. Department of Cardiology, University Hospital of Zurich, Zurich, Switzerland
8. Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland
9. Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland
10. Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland
11. Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland
12. Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland; Department of Cardiology, Schwarzwald-Baar Klinikum, Villingen-Schwenningen, Germany, Switzerland
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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.

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