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
Kerstin Piayda1, MD; Kolja Sievert2; Domenico G Della Rocca3; Oluwaseun G Adeola4; Mohamad Alkhouli5; David Yoo6; Tomás Benito-González7; Ignacio Cruz González8; Roberto Galea9; Carsten Skurk10; Ole de Backer11; Jens Erik Nielsen-Kudsk12; Marek Grygier13; Elijah H. Beaty14; Jim Newton15; Armando Pérez de Prado7; Lorenz Räber9; Douglas Gibson6; Christoffel Van Niekerk6; Christopher R. Ellis4; Rodney P. Horton3; Andrea Natale16; Iris Grundwald17; Tobias Zeus18; Horst Sievert19;
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
As a public service to our readership, this article - peer reviewed by the Editors of EuroIntervention and external reviewers - has been published immediately upon acceptance as it was received in the last round of revision. The content of this article is the responsibility of the authors.
Please note that supplementary movies are not available online at this stage. Once a paper is published in its edited and formatted form, it will be accompanied online by any supplementary movies.
To read the full content of this article, please log in to download the PDF.
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.