The CT derived angle between the transseptal puncture site and the left atrial appendage as a predictor for complex
Dominik Nelles1, Hazem Amli1, Atsushi Sugiura1
1Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany.
Insights
A steeper angle between the intra-atrial septum and left atrial appendage during LAAO procedures indicates increased complexity. This angle predicts longer procedures with more radiation and contrast, but not worse outcomes.
Area of Science:
- Interventional Cardiology
- Cardiac Imaging
- Structural Heart Disease
Background:
- Left atrial appendage occlusion (LAAO) is challenging due to anatomical variations.
- Predicting procedural complexity in LAAO remains difficult.
- Preprocedural cardiac computed tomography (CT) is a valuable tool.
Purpose of the Study:
- To assess the role of the CT-derived angle between the intra-atrial septum (IAS) and left atrial appendage (LAA) in LAAO.
- To determine if this angle predicts procedural complexity and clinical outcomes.
Main Methods:
- Retrospective analysis of 47 patients undergoing LAAO with preprocedural CT.
- Measurement of the angle between the LAA ostium and the transseptal puncture site on the IAS.
- Comparison of procedural characteristics and outcomes based on the median angle.
Main Results:
- The median IAS-LAA angle was 127.3°.
- A steeper angle (below median) correlated with longer procedure times (55.0 vs. 41.3 min, p=0.04).
- Steeper angles led to increased radiation time, contrast use, and sheath exchanges, but not worse procedural outcomes or leaks.
Conclusions:
- The IAS-LAA angle may predict procedural difficulty in LAAO.
- A steeper angle indicates a more complex procedure requiring more resources.
- Procedural outcomes were not negatively impacted by steeper angles in this study.
Objective:
To evaluate the role of the CT-derived angle between the intra-atrial septum (IAS) and the left atrial appendage (LAA) on procedural complexity and clinical outcomes in left atrial appendage occlusion (LAAO) procedures.
Background:
Given the broad variations in anatomy, LAAO remains one of the most challenging interventional procedures in structural heart disease. In recent years, preprocedural cardiac tomography (CT) has evolved as a valuable tool; however, prediction of procedural complexity remains cumbersome.
Methods:
We retrospectively analyzed 47 patients that underwent LAAO at our center in whom pre-procedural cardiac CT-scans were available. Among other baseline parameters, we measured the angle between the LAA ostium and the preferred transseptal puncture site at the IAS. We compared patients with an angle above and below the median regarding procedural characteristics and procedural outcome.
Results:
The median angle between the LAA and the IAS was 127.3° (IQR: 120.9-141.3). LAAO took longer in patients with a measured angle below the median (55.0 ± 22.7 min vs. 41.3 ± 17.5 min; p = .04), resulting in longer radiation times (13.0 ± 5.3 min vs. 9.8 ± 5.7 min; p = .04) and more contrast use (61.1 ± 47.5 mL vs. 33.6 ± 24.7 mL; p = .05). Moreover, the necessity for a sheath exchange was significantly higher (30.4% vs. 4.2%, p = .02) and device repositioning or device resizing trended to be more frequent (26.1% vs. 8.3%; p = .1 and 21.7% vs. 8.3%; p = .2). There were no differences in procedural outcome, device-position and peri-device leak (PDL).
Conclusions:
The angle between the transseptal puncture site and the LAA ostium may serve as a predictor for more demanding LAAO interventions. In our study a steeper angle led to a prolonged procedure resulting in higher doses of contrast and radiation, but was not associated with a worse procedural outcome.
