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Published on: February 26, 2013
Percutaneous Occlusion of the Left Atrial Appendage with Thrombus Irresponsive to Antithrombotic Therapy
Krzysztof Kaczmarek1, Iwona Cygankiewicz1, Witold Streb2
1Department of Electrocardiology, Medical University of Lodz, Pomorska Str 251, 92-213 Lodz, Poland.
Insights
Percutaneous left atrial appendage closure (PLAAC) effectively treats left atrial appendage thrombus (LAAT) resistant to anticoagulation. This minimally invasive procedure shows promise even for patients with mechanical heart valves, with no major complications observed.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Left atrial appendage thrombus (LAAT) poses a significant risk for thromboembolic events, especially in patients unresponsive to antithrombotic therapy.
- Managing LAAT in patients with mechanical heart valves presents unique challenges due to contraindications for certain anticoagulants.
Purpose of the Study:
- To evaluate the safety and efficacy of percutaneous left atrial appendage closure (PLAAC) for treating LAAT unresponsive to antithrombotic therapy.
- To assess PLAAC outcomes in a cohort including patients with mechanical heart valves.
Main Methods:
- Retrospective analysis of clinical and procedural data from 17 patients undergoing PLAAC for LAAT across three high-volume centers.
- Data included patient demographics, pre-procedural LAAT characteristics, procedural details, and mid-term follow-up outcomes.
Main Results:
- Successful occluder implantation in all 17 patients; one patient had a residual leak.
- No procedural complications were reported. Mid-term follow-up (median 10 months) showed no thromboembolism or procedure-related complications.
- One patient developed device-related thrombus at six-month follow-up TEE.
Conclusions:
- Percutaneous left atrial appendage closure is a viable and effective treatment for LAAT resistant to antithrombotic therapy.
- PLAAC can be safely performed in patients with mechanical heart valves, offering an alternative treatment strategy.
Abstract:
We analyzed clinical experience with percutaneous closure of instances of left atrial appendage with thrombus (LAAT) irresponsive to antithrombotic therapy in patients treated in three high-volume cardiology centers. Clinical and procedural data regarding consecutive patients who underwent percutaneous left atrial appendage closure (PLAAC) due to LAAT were retrospectively analyzed. The study population consisted of 17 patients (11 men; 68 ± 14 years; CHA2DS2VASC 4.7 ± 1.9; HASBLED 3 (0-5)) with LAAT confirmed by transesophageal echocardiography, and included 5 patients with mechanical heart valves. Most of the patients (94.1%) received anticoagulation therapy before PLAAC. All LAATs were located in distal portions of the appendage and occupied less than 30% of its volume. Occluding-device implantation was successful in 17 patients; in one, a residual leak was disclosed. Appropriate positioning of occluders required more than 1 attempt in 6 individuals (35.3%); in 3 others (17.6%), the subjects' devices had contact with thrombi. No procedural complications were noted. Midterm follow-up (median: 10 months) revealed no procedure-related complications or clinically diagnosed thromboembolism. Transesophageal echocardiography (TEE) performed after six months revealed device-related thrombus in one patient. We concluded that LAAT irresponsive to antithrombotic therapy might be effectively treated with PLAAC, even in patients with mechanical-valve prostheses.
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