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Diario Oficial de la Sociedad Mexicana de Cirugía Cardiaca, A.C., y del Colegio Mexicano de Cirugía Cardiovascular y Torácica, A.C.

2024, Number 1

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Cir Card Mex 2024; 9 (1)

Peridevice leaks after left atrial appendage occluders. Frequency and relationship with stroke and systemic embolic events

García-Villarreal OA

Language: English
References: 5
Page: 36-36
PDF size: 142.44 Kb.


ABSTRACT

The results of the use of left atrial appendage occlusion devices in patients with atrial fibrillation have recently been reported. In the randomized controlled study Amulet IDE, 1,878 patients in 108 hospital centers were compared using two types of occluders. Although the 3-year results are quite encouraging from the point of view of freedom from the use of warfarin [Amulet (96.2%) vs Watchman (92.5%] , it is worth highlighting the rate of systemic embolism and/or stroke after the application of such devices (5.0% vs 4.6%, respectively). Of note, the peri-device leak (PDL) ≥3 mm is related to and can lead to ischemic events and/or stroke, as well as cardiovascular deaths.
The FDA has accepted a PDL≤5 mm as an adequate “closure” after application of the occluder, and allows the interruption of the use of warfarin, being replaced by dual antiplatelet therapy. However, the clinical consequences of these PDLs may be devastating. A PDL≤5 at 1-year increases the 5-year risk of stroke or systemic embolism (HR: 1.94; 95% CI: 1.15-3.29; P = 0.014).


REFERENCES

  1. Lakkireddy D, Thaler D, Ellis CR, et al. 3-Year Outcomes from the Amplatzer AmuletLeft Atrial Appendage Occluder Randomized Controlled Trial (Amulet IDE). JACCCardiovasc Interv. 2023;16(15):1902-1913. doi: 10.1016/j.jcin.2023.06.022.

  2. Dukkipati SR, Holmes DR Jr, Doshi SK, et al. Impact of Peridevice Leak on 5-YearOutcomes After Left Atrial Appendage Closure. J Am Coll Cardiol. 2022;80(5):469-483. doi: 10.1016/j.jacc.2022.04.062.

  3. Viles-Gonzalez JF, Kar S, Douglas P, et al.The clinical impact of incomplete left atrialappendage closure with the Watchman Device in patients with atrial fibrillation: aPROTECT AF (Percutaneous Closure of the Left Atrial Appendage Versus WarfarinTherapy for Prevention of Stroke in Patients with Atrial Fibrillation) substudy. J AmColl Cardiol. 2012 Mar 6;59(10):923-9. doi: 10.1016/j.jacc.2011.11.028.

  4. Garcia-Villarreal OA. Surgical Closure of the Left Atrial Appendage. Basal Considerationsbefore attempting with Occluder Devices. J Surg Open Access 2017; 3(2): doihttp://dx.doi.org/10.16966/2470-0991.144.

  5. Aryana A, Singh SK, Singh SM, et al. Association between incomplete surgical ligationof left atrial appendage and stroke and systemic embolization. Heart Rhythm.2015;12(7):1431-7. doi: 10.1016/j.hrthm.2015.03.028.




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