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

Prevalence, Mechanisms and Impact of Residual Patency and Device-Related Thrombosis Following Left Atrial Appendage Occlusion: a Computed Tomography Analysis.

DOI: 10.4244/EIJ-D-21-00320

1. Doctor Josep Trueta University Hospital of Girona: Hospital Universitari de Girona Doctor Josep Trueta, Cardiology, Girion, Girona, Spain
2. Interventional Cardiology Unit, Cardiology Department. Hospital de la Santa Creu i Sant Pau. Universitat Autònoma de Barcelona.
3. Cardiac Imaging Unit, Cardiology Department. Hospital de la Santa Creu i Sant Pau. Universitat Autònoma de Barcelona.
4. Interventional Cardiology Unit, Cardiology Department. Hospital de la Santa Creu i Sant Pau, University Autonoma de Barcelona, Spain

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Background: Cardiac computed tomography angiography (CCTA) appears to be an appropriate imaging technique for device surveillance after left atrial appendage occlusion (LAAO). However the available experience is limited.

 Aims: To determine the prevalence, mechanisms and clinical impact of left atrial appendage (LAA) patency and device-related thrombosis (DRT) following LAAO utilising a novel CCTA-based classification.

 Methods: Consecutively enrolled patients who underwent LAAO with Amplatzer device were followed-up with CCTA. Mechanisms and frequency of residual patency were evaluated and correlated with clinical events. Atrial-side device thrombus, device positioning and presence of signs of device stability were also analysed.

Results: 137 patients were included. LAA patency was observed in 56.9% (n=78). Mechanisms and frequency of patency were: malapposition of proximal segment of the device lobe (55.1%), peri-device leak (PDL, 34.6%) and fabric permeability (5.8%). Lobe-LAA axis misalignment was the only independent predictor of device patency after LAAO (HR: 38.3; 95% CI: 13.6 - 107.0; p<0.001). After a median follow-up of 638 days, patency was not associated with an increased risk of death (all-cause or cardiovascular death) or cerebral/peripheral embolism regardless of its mechanism.  Any degree of hypo-attenuated thickening was found in 16.8% (n=23) of patients; of which 16 (11.7%) had low-grade HAT and 7 patients (5.1%) had high-grade HAT or definite DRT.  Complete sealing was associated with increased rates of low-grade HAT. 

Conclusions: LAA patency on CCTA follow-up is a frequent phenomenon due to malapposition of the proximal segment of the device lobe, PDL or fabric permeability.  Patency was not associated with adverse outcomes. Low-grade HAT may be related to a benign, uneventful, endothelialisation process favored by complete LAAO.

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