Safety and feasibility of peri-device leakage closure after LAAO: an international, multicentre collaborative study

Piayda, Kerstin and Sievert, Kolja and Della Rocca, Domenico G. and Adeola, Oluwaseun G. and Alkhouli, Mohamad and Yoo, David and Benito-González, Tomas and Cruz-González, Ignatio and Galea, Roberto and Skurk, Carsten and De Backer, Ole and Nielsen-Kudsk, Jens Erik and Grygier, Marek and Beaty, Elijah H. and Newton, Jim and Pérez de Prado, Armando and Räber, Lorenz and Gibson, Douglas and Van Niekerk, Christoffel and Ellis, Christopher R. and Horton, Rodney P. and Natale, Andrea and Grunwald, Iris Q. and Zeus, Tobias and Sievert, Horst (2021) Safety and feasibility of peri-device leakage closure after LAAO: an international, multicentre collaborative study. EuroIntervention, 17 (12). e1033-e1040. ISSN 1969-6213

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Official URL: https://doi.org/10.4244/EIJ-D-21-00286

Abstract

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: The aim of this study was to assess the safety and feasibility of PDL closure after LAAO. Methods: Fifteen centres 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. The majority of PDLs were detected within 90 days (range 41-231). Detachable coils were the most frequent approach (42.3%), followed by the use of the AMPLATZER Vascular Plug II (29.8%) and the AMPLATZER Duct Occluder II (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 patients had a leak >5 mm. Major adverse events during follow-up occurred in 5 patients (2 ischaemic strokes, 2 intracranial haemorrhages, and 1 major gastrointestinal bleeding). Conclusions: Several interventional techniques have become available to achieve PDL closure. They are associated with high technical and functional success and low complication rates.

Item Type: Journal Article
Keywords: atrial fibrillation, laa closure, stroke
Faculty: Faculty of Health, Education, Medicine & Social Care
Depositing User: Lisa Blanshard
Date Deposited: 10 Jan 2022 12:38
Last Modified: 10 Jan 2022 12:38
URI: https://arro.anglia.ac.uk/id/eprint/707246

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