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Cepas-Guillén P, Flores-Umanzor E, Leduc N, Bajoras V, Perrin N, Farjat-Pasos J, McInerney A, Lafond A, Millán X, Zendjebil S, O'Hara G, Ibrahim R, de Backer O, Cruz-González I, Arzamendi D, Sanchis L, Garot P, Nielsen-Kudsk JE, Nombela-Franco L, Aminian A, Rodés-Cabau J, Freixa X. Impact of Device Implant Depth After Left Atrial Appendage Occlusion. JACC Cardiovasc Interv 2023; 16:2139-2149. [PMID: 37565966 DOI: 10.1016/j.jcin.2023.05.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 05/23/2023] [Accepted: 05/30/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Device-related thrombus (DRT) remains one of the main concerns after left atrial appendage occlusion (LAAO). Several risk factors have been proposed, but most cannot be modulated. A modifiable factor such as device implantation depth is a potential target to adjust the risk for DRT. OBJECTIVES The aim of this study was to assess the impact of LAAO device implantation depth as a predisposing factor for DRT. METHODS The study included patients who underwent successful LAAO at 9 centers in Europe and Canada. Patients were classified into 2 groups: proximal device implantation (covered pulmonary ridge [PR] in the lobe and disc cohort or <5 mm from the PR in the single-lobe cohort) and distal device implantation (uncovered PR in the disc and lobe cohort and ≥5 mm in the single-lobe cohort). RESULTS A total of 1,317 patients were included. Among these, proximal and distal device implantation was achieved in 732 (55%) and 585 (45%) patients, respectively. No differences in procedural outcomes were observed between the groups. At follow-up, patients with proximal implantation had a lower incidence of DRT (2.3%) than those with distal implantation (12.2%) (P < 0.001). Deeper device implantation and a larger uncovered left atrial appendage area were associated with a higher incidence of DRT (P < 0.001), regardless of device type. In multivariable analysis, distal implant (HR: 5.92; 95% CI: 3.39-10.36) and no or single antiplatelet therapy (HR: 1.62; 95% CI: 0.99-2.62) emerged as independent predictors of DRT. CONCLUSIONS LAAO device implantation depth is an independent risk factor for DRT. Deeper device implantation and larger uncovered left atrial appendage areas were associated with a higher incidence of DRT.
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Affiliation(s)
- Pedro Cepas-Guillén
- Institut Clinic Cardiovascular, Hospital Clinic de Barcelona, IDIBAPS, Barcelona, Spain
| | | | - Nina Leduc
- Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
| | - Vilhemas Bajoras
- Rigshospitalet, Copenhagen, Denmark; Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania; Department of Interventional Cardiology, Division of Cardiology and Vascular Diseases, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania
| | - Nils Perrin
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Julio Farjat-Pasos
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | - Ana Lafond
- Hospital Universitario de Salamanca, Salamanca, Spain
| | - Xavi Millán
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Sandra Zendjebil
- Institut Cardiovasculaire Paris-Sud, Hôpital Jacques Cartier, Ramsay-Santé, Massy, France
| | - Gilles O'Hara
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Reda Ibrahim
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | | | | | | | - Laura Sanchis
- Institut Clinic Cardiovascular, Hospital Clinic de Barcelona, IDIBAPS, Barcelona, Spain
| | - Philippe Garot
- Institut Cardiovasculaire Paris-Sud, Hôpital Jacques Cartier, Ramsay-Santé, Massy, France
| | | | | | - Adel Aminian
- Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
| | - Josep Rodés-Cabau
- Institut Clinic Cardiovascular, Hospital Clinic de Barcelona, IDIBAPS, Barcelona, Spain; Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Xavier Freixa
- Institut Clinic Cardiovascular, Hospital Clinic de Barcelona, IDIBAPS, Barcelona, Spain.
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Iriart X, Blanc G, Bouteiller XP, Legghe B, Bouyer B, Sridi-Cheniti S, Bustin A, Vasile C, Thambo JB, Elbaz M, Cochet H. Clinical Implications of CT-detected Hypoattenuation Thickening on Left Atrial Appendage Occlusion Devices. Radiology 2023; 308:e230462. [PMID: 37668517 DOI: 10.1148/radiol.230462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
Background At follow-up CT after left atrial appendage occlusion (LAAO), hypoattenuation thickening (HAT) on the atrial aspect of the device is a common finding but the clinical implications require further study. Purpose To assess the association of HAT grade at follow-up CT with clinical characteristics and outcomes in patients who underwent LAAO. Materials and Methods This prospective study included consecutive participants with atrial fibrillation and who were at high risk for stroke (CHA2DS2-VASc score ≥4) who underwent LAAO and were administered pacifier or nonpacifier devices at two French medical centers between January 2012 and November 2020. Postprocedure CT images were evaluated by two radiologists in consensus and device-specific interpretation algorithms were applied to classify HAT as low grade (low suspicion of thrombosis) or high grade (high suspicion of thrombosis). The association between HAT grade and clinical characteristics was assessed using multinomial logistic regression, and variables associated with risk of stroke were assessed using a Cox proportional hazard model. Results This study included 412 participants (mean age, 76 years ± 8 [SD]; 284 male participants) who underwent follow-up CT at a mean of 4.2 months ± 1.7 after LAAO. Low-grade and high-grade HAT were depicted in 98 of 412 (23.8%) and 21 of 412 (5.1%) participants, respectively. High-grade HAT was associated with higher odds of antithrombotic drug discontinuation during follow-up (odds ratio, 9.5; 95% CI: 3.1, 29.1; P < .001), whereas low-grade HAT was associated with lower odds of persisting left atrial appendage patency (odds ratio, 0.46; 95% CI: 0.27, 0.79; P = .005). During a median follow-up of 17 months (IQR, 11-41 months), stroke occurred in 24 of 412 (5.8%) participants. High-grade HAT was associated with stroke (hazard ratio, 4.6; 95% CI: 1.5, 14.0; P = .008) and low-grade HAT (P = .62) was not. Conclusion Low-grade HAT was a more common finding at CT performed after LAAO CT (24%) than was high-grade HAT (5%), but it was associated with more favorable outcomes than high-grade HAT, which was associated with higher stroke risk. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Choe in this issue.
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Affiliation(s)
- Xavier Iriart
- From the IHU Liryc, CHU/Univ Bordeaux/Inserm 1045, IHU Liryc, Electrophysiology and Heart Modelling Institute, Bordeaux University Foundation, Inserm U1045, Avenue de Magellan, 33604 Pessac, France (X.I., X.P.B., A.B., J.B.T., H.C.); Department of Cardiac Imaging, CHU Bordeaux, Pessac, France (B.L., S.S.C., H.C.); Department of Pediatric and Adult Congenital Heart Disease, M3C National Reference Centre, Bordeaux University Hospital, Bordeaux-Pessac, France (X.I., B.B., C.V., J.B.T.); and Department of Cardiology, CHU de Toulouse, Toulouse, France (G.B., M.E.)
| | - Gregoire Blanc
- From the IHU Liryc, CHU/Univ Bordeaux/Inserm 1045, IHU Liryc, Electrophysiology and Heart Modelling Institute, Bordeaux University Foundation, Inserm U1045, Avenue de Magellan, 33604 Pessac, France (X.I., X.P.B., A.B., J.B.T., H.C.); Department of Cardiac Imaging, CHU Bordeaux, Pessac, France (B.L., S.S.C., H.C.); Department of Pediatric and Adult Congenital Heart Disease, M3C National Reference Centre, Bordeaux University Hospital, Bordeaux-Pessac, France (X.I., B.B., C.V., J.B.T.); and Department of Cardiology, CHU de Toulouse, Toulouse, France (G.B., M.E.)
| | - Xavier Paul Bouteiller
- From the IHU Liryc, CHU/Univ Bordeaux/Inserm 1045, IHU Liryc, Electrophysiology and Heart Modelling Institute, Bordeaux University Foundation, Inserm U1045, Avenue de Magellan, 33604 Pessac, France (X.I., X.P.B., A.B., J.B.T., H.C.); Department of Cardiac Imaging, CHU Bordeaux, Pessac, France (B.L., S.S.C., H.C.); Department of Pediatric and Adult Congenital Heart Disease, M3C National Reference Centre, Bordeaux University Hospital, Bordeaux-Pessac, France (X.I., B.B., C.V., J.B.T.); and Department of Cardiology, CHU de Toulouse, Toulouse, France (G.B., M.E.)
| | - Benoit Legghe
- From the IHU Liryc, CHU/Univ Bordeaux/Inserm 1045, IHU Liryc, Electrophysiology and Heart Modelling Institute, Bordeaux University Foundation, Inserm U1045, Avenue de Magellan, 33604 Pessac, France (X.I., X.P.B., A.B., J.B.T., H.C.); Department of Cardiac Imaging, CHU Bordeaux, Pessac, France (B.L., S.S.C., H.C.); Department of Pediatric and Adult Congenital Heart Disease, M3C National Reference Centre, Bordeaux University Hospital, Bordeaux-Pessac, France (X.I., B.B., C.V., J.B.T.); and Department of Cardiology, CHU de Toulouse, Toulouse, France (G.B., M.E.)
| | - Benjamin Bouyer
- From the IHU Liryc, CHU/Univ Bordeaux/Inserm 1045, IHU Liryc, Electrophysiology and Heart Modelling Institute, Bordeaux University Foundation, Inserm U1045, Avenue de Magellan, 33604 Pessac, France (X.I., X.P.B., A.B., J.B.T., H.C.); Department of Cardiac Imaging, CHU Bordeaux, Pessac, France (B.L., S.S.C., H.C.); Department of Pediatric and Adult Congenital Heart Disease, M3C National Reference Centre, Bordeaux University Hospital, Bordeaux-Pessac, France (X.I., B.B., C.V., J.B.T.); and Department of Cardiology, CHU de Toulouse, Toulouse, France (G.B., M.E.)
| | - Soumaya Sridi-Cheniti
- From the IHU Liryc, CHU/Univ Bordeaux/Inserm 1045, IHU Liryc, Electrophysiology and Heart Modelling Institute, Bordeaux University Foundation, Inserm U1045, Avenue de Magellan, 33604 Pessac, France (X.I., X.P.B., A.B., J.B.T., H.C.); Department of Cardiac Imaging, CHU Bordeaux, Pessac, France (B.L., S.S.C., H.C.); Department of Pediatric and Adult Congenital Heart Disease, M3C National Reference Centre, Bordeaux University Hospital, Bordeaux-Pessac, France (X.I., B.B., C.V., J.B.T.); and Department of Cardiology, CHU de Toulouse, Toulouse, France (G.B., M.E.)
| | - Aurélien Bustin
- From the IHU Liryc, CHU/Univ Bordeaux/Inserm 1045, IHU Liryc, Electrophysiology and Heart Modelling Institute, Bordeaux University Foundation, Inserm U1045, Avenue de Magellan, 33604 Pessac, France (X.I., X.P.B., A.B., J.B.T., H.C.); Department of Cardiac Imaging, CHU Bordeaux, Pessac, France (B.L., S.S.C., H.C.); Department of Pediatric and Adult Congenital Heart Disease, M3C National Reference Centre, Bordeaux University Hospital, Bordeaux-Pessac, France (X.I., B.B., C.V., J.B.T.); and Department of Cardiology, CHU de Toulouse, Toulouse, France (G.B., M.E.)
| | - Corina Vasile
- From the IHU Liryc, CHU/Univ Bordeaux/Inserm 1045, IHU Liryc, Electrophysiology and Heart Modelling Institute, Bordeaux University Foundation, Inserm U1045, Avenue de Magellan, 33604 Pessac, France (X.I., X.P.B., A.B., J.B.T., H.C.); Department of Cardiac Imaging, CHU Bordeaux, Pessac, France (B.L., S.S.C., H.C.); Department of Pediatric and Adult Congenital Heart Disease, M3C National Reference Centre, Bordeaux University Hospital, Bordeaux-Pessac, France (X.I., B.B., C.V., J.B.T.); and Department of Cardiology, CHU de Toulouse, Toulouse, France (G.B., M.E.)
| | - Jean-Benoit Thambo
- From the IHU Liryc, CHU/Univ Bordeaux/Inserm 1045, IHU Liryc, Electrophysiology and Heart Modelling Institute, Bordeaux University Foundation, Inserm U1045, Avenue de Magellan, 33604 Pessac, France (X.I., X.P.B., A.B., J.B.T., H.C.); Department of Cardiac Imaging, CHU Bordeaux, Pessac, France (B.L., S.S.C., H.C.); Department of Pediatric and Adult Congenital Heart Disease, M3C National Reference Centre, Bordeaux University Hospital, Bordeaux-Pessac, France (X.I., B.B., C.V., J.B.T.); and Department of Cardiology, CHU de Toulouse, Toulouse, France (G.B., M.E.)
| | - Meyer Elbaz
- From the IHU Liryc, CHU/Univ Bordeaux/Inserm 1045, IHU Liryc, Electrophysiology and Heart Modelling Institute, Bordeaux University Foundation, Inserm U1045, Avenue de Magellan, 33604 Pessac, France (X.I., X.P.B., A.B., J.B.T., H.C.); Department of Cardiac Imaging, CHU Bordeaux, Pessac, France (B.L., S.S.C., H.C.); Department of Pediatric and Adult Congenital Heart Disease, M3C National Reference Centre, Bordeaux University Hospital, Bordeaux-Pessac, France (X.I., B.B., C.V., J.B.T.); and Department of Cardiology, CHU de Toulouse, Toulouse, France (G.B., M.E.)
| | - Hubert Cochet
- From the IHU Liryc, CHU/Univ Bordeaux/Inserm 1045, IHU Liryc, Electrophysiology and Heart Modelling Institute, Bordeaux University Foundation, Inserm U1045, Avenue de Magellan, 33604 Pessac, France (X.I., X.P.B., A.B., J.B.T., H.C.); Department of Cardiac Imaging, CHU Bordeaux, Pessac, France (B.L., S.S.C., H.C.); Department of Pediatric and Adult Congenital Heart Disease, M3C National Reference Centre, Bordeaux University Hospital, Bordeaux-Pessac, France (X.I., B.B., C.V., J.B.T.); and Department of Cardiology, CHU de Toulouse, Toulouse, France (G.B., M.E.)
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