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Published on: February 26, 2013
Long-Term Outcomes of Minimalist Left Atrial Appendage Occlusion Guided Only by Periprocedural Imaging
Siu-Fung Wong1,2, Christopher Broyd1, Cara Hanley1
1Department of Cardiology, Sussex Cardiac Centre, University Hospitals Sussex, Brighton, UK.
Insights
A minimalistic approach to left atrial appendage occlusion (LAAO) using only peri-procedural imaging is safe and effective. This method reduces cerebrovascular events without compromising procedural success.
Area of Science:
- Cardiology
- Medical Devices
- Interventional Procedures
Background:
- Pre- and post-procedural imaging in LAAO increases patient burden and risk.
- Current imaging protocols may not significantly impact LAAO outcomes.
- A focused, peri-procedural imaging strategy might be sufficient.
Purpose of the Study:
- To evaluate the feasibility and safety of a minimalistic imaging approach in LAAO.
- To assess the efficacy and long-term outcomes of LAAO performed with only peri-procedural imaging.
- To determine if this approach impacts cerebrovascular events and other complications.
Main Methods:
- Retrospective analysis of 247 patients undergoing LAAO between 2009 and 2024.
- Exclusion of patients with pre- and post-procedure imaging.
- Recording of procedural success, complications, and long-term outcomes (stroke, bleeding, death) via health records.
Main Results:
- Successful LAAO achieved in 99.2% of patients.
- Periprocedural complications occurred in 2.4% of patients.
- Long-term follow-up (1155 patient-years) showed a 67% reduction in clinical stroke and a 55% reduction in major bleeding compared to expected rates based on risk scores.
Conclusions:
- Minimalistic LAAO using only peri-procedural imaging is feasible and safe.
- This approach demonstrates an excellent success rate.
- It leads to a significant long-term reduction in cerebrovascular events.
Background:
Pre- and post-procedural imaging in left atrial appendage occlusion (LAAO) adds to patient inconvenience and risks and may not materially influence outcomes. A more focused approach involving only peri-procedural imaging may suffice.
Methods And Results:
Data from patients who had LAAO at our centre between 2009 and 2024 were examined. Those with pre- and post-procedure imaging studies were excluded. Efficacy outcomes including procedural success and periprocedural complication were recorded. Long-term outcomes comprising cerebrovascular events, major bleeding, cardiovascular and all-cause death were retrieved through review of regional and national digital health records. 247 patients met the analysis criteria. The median CHA2DS2-VASc and HAS-BLED scores were 4 [interquartile range (IQR) 3-5)] and 3 (IQR 3-4) respectively. Successful closure of the left atrial appendage was achieved in 245 (99.2%) patients. Periprocedural death and complications occurred in 0.4% and 2.4% of patients respectively. Follow-up was obtained for 1155 patient-years (median follow-up time 6.8 years). Clinical stroke occurred in 6.9% of patients (1.55 per 100 patient-years)-a 67% reduction compared to that expected from the CHA2DS2-VASc score. 11.4% of patients suffered from major bleeding (2.56 per 100 patient-years)-a 55% reduction compared to that expected from the HAS-BLED score. 40.8% (8.65 per 100 patient-years) of patients died during follow-up. Patients suffering from cerebrovascular events had higher CHA2DS2-VASc (p = 0.048) and HAS-BLED scores (p = 0.045).
Conclusion:
A minimalistic approach in LAAO using only periprocedural imaging guidance is feasible and safe, with an excellent success rate and a resultant reduction in cerebrovascular events in long-term.
