Amplatzer left atrial appendage closure: Single versus combined procedures

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Cardiac Surgery

Background:

• Elderly patients frequently present with multiple cardiac conditions requiring simultaneous interventions.
• Optimizing patient outcomes necessitates efficient treatment strategies for complex cardiac conditions.

Purpose of the Study:

• To compare procedural and long-term clinical outcomes of left atrial appendage closure (LAAC) using Amplatzer devices.
• To evaluate LAAC as a standalone procedure versus a combined approach with other structural or coronary interventions.

Main Methods:

• A total of 559 patients underwent LAAC with Amplatzer devices across two Swiss university hospitals.
• Procedures were categorized as either single LAAC or combined with other interventions (e.g., PCI, PFO closure, TAVI).
• Primary endpoints included peri-procedural complications, major bleeding, stroke, systemic embolism, and cardiovascular death, assessed per 100 patient-years.

Main Results:

• Device success rates were high and comparable between single (96.6%) and combined (99.0%) procedures (p=0.08).
• After a mean follow-up of 2.5-2.6 years, primary efficacy endpoints (stroke, embolism, death) were similar (5.9% vs. 5.0%; HR 1.2).
• Primary safety endpoints (complications, bleeding) were also comparable between groups (3.7% vs. 3.8%; HR 1.0).

Conclusions:

• Left atrial appendage closure (LAAC) with Amplatzer devices is procedurally feasible and safe when combined with structural, coronary, or electrophysiological interventions.
• Combined LAAC procedures demonstrate comparable long-term safety and efficacy to standalone LAAC.