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

Safety and Feasibility of Peri-device Leakage Closure after LAAO: An International, Multi-center Collaborative Study

DOI: 10.4244/EIJ-D-21-00286

1. CVC Frankfurt, Cardiology, Frankfurt, Germany
2. Cardiovascular Center (CVC) Frankfurt, Frankfurt, Germany
3. Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX, USA
4. Vanderbilt Heart and Vascular Institute, Nashville, TN, USA
5. Mayo Clinic, Rochester, MN, USA
6. Scripps Health, La Jolla, CA, USA
7. University Hospital of León, León, Spain
8. University Hospital of Salamanca, Ibsal, Cibercv, Spain
9. Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
10. Charité Berlin, Berlin, Germany
11. Rigshospitalet, Copenhagen, Denmark
12. University Hospital Aarhus, Aarhus, Denmark
13. Poznan University of Medical Sciences, Poznan, Poland
14. Wake Forest Baptist Health, Winston-Salem, NC, USA
15. Nuffield Health, Oxford, United Kingdom
16. Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX, USA; Scripps Health, La Jolla, CA, USA
17. University of Dundee, United Kingdom
18. University Hospital Düsseldorf, Düsseldorf, Germany
19. Cardiovascular Center (CVC) Frankfurt, Frankfurt, Germany; Anglia Ruskin University, Cambridge, United Kingdom, United Kingdom

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Background: 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.

Aims: To assess safety and feasibility of PDL closure after LAAO.

Methods: Fifteen centers 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. 

Results: A total of 95 patients were included and a cumulative number of 104 leaks were closed. Majority of PDL were detected within 90 days [range 41-231]. Detachable coils were the most frequent approach (42.3%), followed by the use of AmplatzerTM Vascular Plug II (Abbott, Chicago, IL, 29.8%) and the AmplatzerTM Duct Occluder II (Abbott, Chicago, IL, 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<0.001). None of the patient had a leak >5mm. Major adverse events during follow-up occurred in 5 patients (2 ischemic strokes, 2 intracranial hemorrhages, and 1 major gastrointestinal bleeding).

Conclusion: Several interventional techniques have become available to achieve PDL closure.  They are associated with high technical and functional success and low complication rates.

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