Safety and Efficacy of Mini-Invasive Left Atrial Appendage Closure: A Propensity-Score Analysis

Area of Science:

• Cardiology
• Medical Devices
• Interventional Procedures

Background:

• Left atrial appendage closure (LAAC) prevents stroke in nonvalvular atrial fibrillation (NVAF) patients unsuitable for anticoagulation.
• General anesthesia (GA) for transesophageal echocardiography (TEE) guidance in LAAC can be challenging.
• Evaluating a less invasive LAAC approach is crucial for broader patient applicability.

Purpose of the Study:

• To assess the safety and midterm efficacy of a mini-invasive LAAC strategy.
• To compare micro-TEE under procedural sedation with standard 3D TEE under GA for LAAC.

Main Methods:

• Propensity score matching compared two LAAC cohorts: standard TEE-guided (GA) and mini-invasive (sedation).
• The primary endpoint included embolic/bleeding events, procedural complications, and cardiovascular deaths within 3 months.
• Mini-invasive LAAC was defined as using micro-TEE under procedural sedation.

Main Results:

• The mini-invasive strategy was successful in 96.1% of planned patients.
• The primary endpoint occurred in 11.2% (mini-invasive) vs. 10.3% (standard) (P=0.76).
• Procedural times, fluoroscopy, and hospital stays were significantly shorter with the mini-invasive approach (P<0.001).

Conclusions:

• The mini-invasive LAAC strategy demonstrates comparable safety and efficacy to the standard approach.
• This approach may expand LAAC accessibility as indications grow.
• Micro-TEE under sedation offers a viable alternative for LAAC guidance.