Percutaneous left atrial appendage closure with minimal antithrombotic treatment in patients at very high risk of bleeding events

2012 ◽  
Vol 130 (3) ◽  
pp. e194-e195 ◽  
Author(s):  
Juha Lund ◽  
Antti Saraste ◽  
K.E. Juhani Airaksinen
Keyword(s):  
High Risk ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Atrial Appendage ◽  
Antithrombotic Treatment ◽  
Left Atrial Appendage Closure ◽  
Bleeding Events ◽  
Risk Of Bleeding ◽  
Very High

Left atrial appendage closure device implantation in patients at very high risk for stroke

Heart Rhythm ◽  
2020 ◽  
Vol 17 (1) ◽  
pp. 27-32 ◽  
Author(s):  
Erika Hutt ◽  
Oussama M. Wazni ◽  
Simrat Kaur ◽  
Walid I. Saliba ◽  
Khaldoun G. Tarakji ◽  
...  
Keyword(s):  
High Risk ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Atrial Appendage ◽  
Closure Device ◽  
Left Atrial Appendage Closure ◽  
Device Implantation ◽  
Very High

scholarly journals Influence of severe anemia on procedural safety and one-year outcome after left atrial appendage closure: Insights from a very high-risk cohort

2022 ◽  
Vol 38 ◽  
pp. 100946
Author(s):  
Shinwan Kany ◽  
Johannes Brachmann ◽  
Thorsten Lewalter ◽  
Ibrahim Akin ◽  
Horst Sievert ◽  
...  
Keyword(s):  
High Risk ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Atrial Appendage ◽  
Severe Anemia ◽  
Left Atrial Appendage Closure ◽  
One Year ◽  
Very High ◽  
High Risk Cohort

P1438Predictors and clinical impact of bleeding events after left atrial appendage closure in patients with high risk or a history of bleeding

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
M Sano ◽  
T Fink ◽  
V Sciacca ◽  
J Vogler ◽  
M Saad ◽  
...  
Keyword(s):  
High Risk ◽  
Antiplatelet Therapy ◽  
Major Bleeding ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Atrial Appendage ◽  
Left Atrial Appendage Closure ◽  
Bleeding Events ◽  
History Of ◽  
Or History

Abstract Background Left atrial appendage closure (LAAC) has emerged as an alternative to oral anticoagulation (OAC) for stroke prevention in patients with atrial fibrillation and may be especially attractive in patients with high risk or a history of bleeding. However, data of clinical benefit and incidence of post-procedural bleeding in patients with both high risk of bleeding and ischemic cerebral stroke after LAAC are lacking. Objectives This study sought to identify predictors and the prognostic impact of post-LAAC bleeding in patients at high risk and/or history of bleeding in the direct oral anticoagulant therapy (DOAC) era. Methods and results We retrospectively enrolled a total of 195 patients (75 ± 8.7 years, 38% female, 47% with previous major bleeding, mean CHA2DS2-VASc score 4.3 ± 1.6 and mean HAS-BLED score 2.7 ± 1.1) undergoing endocardial (91%) or epicardial (9%) LAAC during a mean follow-up of 339 ± 319 days. Twenty-three (11.9%) patients developed procedure-unrelated bleeding events after a median of 147 (43, 362) days after LAAC, in 12/23 (52%) patients under single antiplatelet therapy (SAPT), 6/23 (26%) dual antiplatelet therapy (DAPT), 1/23 (4%)  DOAC, 1/23 (4%) VKA, 2/23 (9%) dual therapy (SAPT and DOAC/VKA) and 1/23 (4%) triple therapy (DAPT and DOAC/VKA). (Figure) Diabetes mellitus and previous major bleeding were identified as the independent predictors of post-LAAC bleeding (Odds ratio 2.65 [95% CI:1.04-6.73], p = 0.041, and 5.50 [95% confidence interval:1.72-17.5], p = 0.004). Post-LAAC bleeding was associated with all-cause death (9/23 [39%] vs 18/171 [11%], p = 0.001), but not ischemic stroke/TIA (1/23 [4%] vs 6/171 [4%], p = 0.593) nor device thrombus (2/23 [9%] vs 3/171 [2%], p = 0.108). Kaplan-Meier curve estimated that patients with post-LAAC bleeding had a worse mortality than those without post-LAAC bleeding (3-year mortality; 35.6% [95%CI; 11.6-61.0%] vs 68.7% [45.0-83.8], p = 0.029) Conclusions In AF patients with high bleeding risk or history of bleeding undergoing LAAC, bleeding events are common and may occur even after long-term duration after LAAC. Previous major bleeding history strongly predicts subsequent bleeding events following LAAC and is associated with unfavorable mortality. Further investigations are required to identify optimal post-procedural antithrombotic strategies for patients undergoing LAAC with previous major bleeding. Abstract Figure. The association between time to bleeding

Pericardial Patch Exclusion Technique for Left Atrial Appendage Closure

2018 ◽  
Vol 13 (2) ◽  
pp. 144-146
Author(s):  
Olivia K. Ginty ◽  
Ferns H. Khaliel ◽  
Corey Adams ◽  
Michael W. A. Chu
Keyword(s):  
Left Atrium ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Atrial Appendage ◽  
Pericardial Patch ◽  
Left Atrial Appendage Closure ◽  
Risk Of Bleeding ◽  
Left Atrial Appendage Occlusion ◽  
Autologous Pericardial Patch ◽  
Patch Closure

We describe a technique of left atrial appendage occlusion that consists of autologous pericardial patch closure of the left atrial appendage orifice from within the left atrium. This pericardial patch exclusion technique has little added risk of bleeding, can be performed through sternotomy or right minithoracotomy, and can be used in re-operative situations.

scholarly journals P923 Ultrasound follow-up of left atrial appendage occlusion devices

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
D Molinero ◽  
P Cabeza ◽  
N Hernandez ◽  
W Delgado ◽  
E Silva
Keyword(s):  
Atrial Fibrillation ◽  
High Risk ◽  
Transthoracic Echocardiography ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Atrial Appendage ◽  
Clot Formation ◽  
Risk Of Bleeding ◽  
Rule Out

Abstract Background Left atrial appendage (LAA) occlusion devices represent an important alternative to anticoagulation in patients with atrial fibrillation (AF) with high risk of bleeding and who have suffered any hemorrhagic event. At first, a transesophageal ultrasound is performed to examine cardiac cavities, take measures of LAA and discharge the presence of thrombi. We redo a new transesophageal ultrasound as a control three months later after having installed the device. The purpose of this article is to show our experience in ultrasound follow up of LAA occlusion. Methodology All measures of LAA were taken with the transoesophageal ultrasound device by the same operator. According to the size acquired from the appendage of each patient, they were divided into a first group with the implementation of the Watchman device (23 patients) and Amplatzer (6 patients). A transthoracic echocardiography control was performed on each patient to rule out the presence of complications after the intervention, before to be discharged from hospital. After three months, a new transoesophageal study was repeated to assess the correct position of the device and to rule out the presence of any disfunctions or clot formation. Results A total of 29 patients with AF (CHADSVASC 4.09 HASBLED 2.96) with a high risk of bleeding and after having suffered any complications (41% brain bleeding, 31% major gastrointestinal bleeding, 27% advanced chronic kidney disease) were presented for the implantation of a LAA closure device. Firstly, LAA size was confirm and the presence of a thrombi was rule out. No patient suffered complications during the procedure that was confirmed with transthoracic echocardiography (discharging the presence of perforation, pericardial effusion or tamponade). At three months later, we performed a new transoesophageal as a control for the assessment of the place and presence of GAPs, if any (80% correct-placed, 15% placed with a gap of 2-4 mm with passage of flow throughout). In a 10-month follow-up, it was found that practically 93% of patients were still without anticoagulation, except two patients, one of them (CHADSVASC 4 HASBLED 2) had to reintroduce oral anticoagulation due to the fact of the clot formation on the device. The second one (CHADSVASC 4 HASBLED 2) had to reintroduce temporarily fractionated heparin due to stent thrombosis in the femoral artery. None of them presented any ischemic complications or new haemorrhagic events. Conclusions LAA occlusion devices are an effective and safe alternative to anticoagulation in patients with atrial fibrillation with predisposition to bleeding where ultrasound techniques play an essential role in all stages of procedure (prior to implantation of the device, during and at the follow-up).

Clinical outcomes of Watchman vs. Amplatzer occluders for left atrial appendage closure (WATCH at LAAC)

EP Europace ◽  
2020 ◽  
Vol 22 (6) ◽  
pp. 916-923
Author(s):  
Caroline Kleinecke ◽  
Jiangtao Yu ◽  
Philip Neef ◽  
Eric Buffle ◽  
Stefano de Marchi ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Atrial Appendage ◽  
Comparable Efficacy ◽  
Left Atrial Appendage Closure ◽  
Bleeding Events ◽  
Safety Endpoint ◽  
Procedural Complications

Abstract Aims This study compares clinical outcomes of Watchman vs. Amplatzer devices for left atrial appendage closure (LAAC). Methods and results Of two real-world registries, the Watchman registry Lichtenfels, Germany, and the Amplatzer registry Bern-Zurich, Switzerland, 303 and 333 consecutive patients, respectively, were included. After a 1:1 propensity score matching, 266 vs. 266 patients were compared by use of the predefined primary efficacy endpoint of stroke, systemic embolism and cardiovascular/unexplained death, the primary safety endpoint of major peri-procedural complications and major bleeding events at follow-up, and the combined hazard endpoint, a composite of all above-mentioned hazards. Mean age was 75.3 ± 7.8 (Watchman) vs. 75.1 ± 9.9 (Amplatzer) years, CHA2DS2-VASc score 4.5 ± 1.7 vs. 4.5 ± 1.5, and HAS-BLED score 3.2 ± 1.0 vs. 3.2 ± 1.0. At a mean follow-up of 2.4 ± 1.3 vs. 2.5 ± 1.5 years and 1.322 patient-years, the primary endpoints of efficacy [40/646, 6.2% [Watchman] vs. 43/676, 6.4% [Amplatzer]; hazard ratio (HR), 1.02; 95% confidence interval (CI), 0.66–1.58; P = 0.92] and safety (33/646, 5.1% vs. 30/676, 4.4%; HR, 0.57; 95% CI, 0.29–1.11; P = 0.10), as well as the combined hazard endpoint (69/646, 10.7% vs. 66/676, 9.8%; HR, 0.80; 95% CI, 0.55–1.12; P = 0.26) were similar for both groups. Conclusion This study suggests comparable efficacy and safety of the Watchman and Amplatzer devices.

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