Interventions for hypertension and stroke

Left atrial appendage closure for thrombus trapping: the international, multicentre TRAPEUR registry

EuroIntervention 2022;18:50-57. DOI: 10.4244/EIJ-D-21-00713

Frederic Sebag
Frederic A. Sebag1, MD; Philippe Garot2, MD; Roberto Galea3, MD; Ole De Backer4, MD, PhD; Antoine Lepillier5, MD; Antoine De Meesteer6, MD; David Hildick-Smith7, MD; Sebastien Armero8, MD; Ghassan Moubarak9, MD; Gregory Ducrocq10, MD; Romain Eschalier11, MD, PhD; Adel Aminian12, MD; Antoine Sauguet13, MD; Nicolas Lellouche14, MD, PhD; Khalil Mahmoudi1, MD; Lorenz Räber3, MD, PhD; Nicolas Amabile1, MD, PhD
1. Department of Cardiology, Institut Mutualiste Montsouris, Paris, France; 2. Hôpital Privé Jacques Cartier, Institut Cardiovasculaire Paris Sud (ICPS), Ramsay Santé, Massy, France; 3. Department of Cardiology, Inselspital, Bern, Switzerland; 4. Department of Cardiology, Rigshospital, Copenhagen, Denmark; 5. Department of Cardiology, Centre Cardiologique du Nord, Saint Denis, France; 6. Department of Cardiology, Hôpital de Jolimont, Haine-Saint-Paul, Belgium; 7. Cardiology Department, Royal Sussex Cardiac Centre, Brighton, United Kingdom; 8. Hôpital Européen Marseille, Marseille, France; 9. Clinique Ambroise Paré, Neuilly sur Seine, France; 10. Department of Cardiology, Hôpital Bichat - Claude-Bernard, Paris, France; 11. Department of Cardiology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France; 12. Department of Cardiology, C.H.U. de Charleroi, Charleroi, Belgium; 13. Clinique Pasteur, Toulouse, France; 14. Cardiology Unit, Hôpital Henri-Mondor AP-HP, Créteil, France

Background: Although the presence of a thrombus contraindicates left atrial appendage closure procedure (LAAC), a previous study reported the feasibility of the thrombus trapping procedure (TTP) technique to overcome this limitation.

Aims: This study aimed to analyse the short-term outcomes in a series of patients who underwent LAAC using the TTP (TTP-LAAC).

Methods: This retrospective series included patients who underwent TTP-LAAC between January 2018 and May 2020 in 13 European centres. Device choice, pre-interventional work-up and post-discharge antithrombotic therapy regimens were left to the discretion of the operators. The primary endpoint was the 30-day occurrence of stroke, systemic embolism or cardiovascular death.

Results: During the study period, a total of 1,918 patients underwent LAAC. A thrombus was identified in 71 cases but completely disappeared in 24 patients before procedure. TTP-LAAC was finally performed in 53 cases (3%). Thrombi were identified ahead of the actual day of implantation in 47 patients (87%) and were mostly limited in size (50 cases with extension <50% of the LAA surface). The Amplatzer Amulet and WATCHMAN FLX occluders were implanted in 44 and 9 patients, respectively. A single deployment approach was applied in 70% and a cerebral embolic protection system was used in 9% of the patients. The overall success rate was 100%. Small pericardial effusion without tamponade was observed in 6% of the cases. Patients were discharged with 72% under antiplatelet therapy and 10% under short-term oral anticoagulation. The primary endpoint occurred in one patient.

Conclusions: TTP-LAAC might be used in a minority of LAAC procedures but appears to be feasible and safe in the short-term, in select cases.

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