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Llagostera-Martín M, Cainzos M, Salvatella N, Cubero-Gallego H, Mas-Stachurska A, Sánchez-Carpintero A, Tizón-Marcos H, Calvo-Fernández A, Molina L, Vaquerizo B. Single antiplatelet therapy after left atrial appendage closure in patients with AF: safety and effectiveness. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024; 77:150-157. [PMID: 37879431 DOI: 10.1016/j.rec.2023.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 06/16/2023] [Indexed: 10/27/2023]
Abstract
INTRODUCTION AND OBJECTIVES The optimal antithrombotic strategy following left atrial appendage closure (LAAC) is poorly defined in patients with nonvalvular atrial fibrillation. We assessed the safety and effectiveness of a single antiplatelet treatment (SAPT) strategy after LAAC in a population at high risk of ischemic and bleeding events. METHODS This single-center, observational, prospective study included a consecutive cohort of patients who underwent LAAC using the LAmbre device (Lifetech Scientific, China) and who were discharged with SAPT. The primary outcome was a composite of stroke, systemic embolism, and device-related thrombosis during follow-up. Secondary endpoints were cardiovascular mortality and major bleeding events (BARC ≥3a). Clinical follow-up was performed at 1, 6, and 12 months and subsequently on an annual basis. Transesophageal echocardiography was performed at 1 and 12 months of follow-up. RESULTS The study comprised 74 patients. The median age was 77 [72-83] years and 43% were women. The cohort exhibited a high prevalence of comorbidities and cardiovascular risk factors. The median CHA2DS2-VASc and HAS-BLED scores were 4 [3-6] and 4 [4-5], respectively. The median length of follow-up was 2.5 years (188 patients-year). During follow-up, device-related thrombosis occurred in 3 patients (4%). Ischemic stroke occurred in 1 patient (1.3%, rate 0.5%/y), representing a 90.9% relative risk reduction compared with the risk predicted by CHA2DS2-VASc. Major bleeding events occurred in 12 patients (16%, 6.4%/y), with a relative risk reduction of 26.4% of that predicted by HAS-BLED. Cardiovascular-related mortality was observed in 2 patients (2.7%). CONCLUSIONS SAPT appears to be a safe and effective treatment following LAAC in patients at high ischemic and hemorrhagic risk. Further studies are needed to confirm our findings.
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Affiliation(s)
| | - Miguel Cainzos
- Servicio de Cardiología, Hospital del Mar, Barcelona, Spain; Grupo de Investigación en Enfermedades del Corazón (GREC), Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain
| | | | - Héctor Cubero-Gallego
- Servicio de Cardiología, Hospital del Mar, Barcelona, Spain; Grupo de Investigación en Enfermedades del Corazón (GREC), Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain
| | - Aleksandra Mas-Stachurska
- Servicio de Cardiología, Hospital del Mar, Barcelona, Spain; Servicio de Cardiología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Helena Tizón-Marcos
- Servicio de Cardiología, Hospital del Mar, Barcelona, Spain; Grupo de Investigación en Enfermedades del Corazón (GREC), Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Alicia Calvo-Fernández
- Servicio de Cardiología, Hospital del Mar, Barcelona, Spain; Departamento de Medicina, Universidad Pompeu Fabra, Barcelona, Spain
| | - Luis Molina
- Servicio de Cardiología, Hospital del Mar, Barcelona, Spain; Grupo de Investigación en Enfermedades del Corazón (GREC), Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain; Departamento de Medicina, Universidad Pompeu Fabra, Barcelona, Spain
| | - Beatriz Vaquerizo
- Servicio de Cardiología, Hospital del Mar, Barcelona, Spain; Grupo de Investigación en Enfermedades del Corazón (GREC), Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain; Departamento de Medicina, Universidad Pompeu Fabra, Barcelona, Spain; Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
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Llagostera-Martín M, Cubero-Gallego H, Mas-Stachurska A, Salvatella N, Sánchez-Carpintero A, Tizon-Marcos H, Garcia-Guimaraes M, Calvo-Fernandez A, Molina L, Vaquerizo B. Left Atrial Appendage Closure with a New Occluder Device: Efficacy, Safety and Mid-Term Performance. J Clin Med 2021; 10:1421. [PMID: 33915971 PMCID: PMC8036586 DOI: 10.3390/jcm10071421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 03/17/2021] [Accepted: 03/26/2021] [Indexed: 11/17/2022] Open
Abstract
The LAmbreTM device is a novel system designed for left atrial appendage closure (LAAC). First registries showed a high rate of device implantation success. However, few mid-term results are available. We present our 1- and 12-month follow-up results for this device. This prospective, single-center registry included consecutive patients with nonvalvular atrial fibrillation who underwent LAAC with the LAmbreTM device. Transesophageal echocardiography (TEE) was performed at 1-month follow-up. In total, 55 patients were included. The population was elderly (75 ± 9.4 years), with a high proportion of comorbidities. The mean CHA2DS2-VASc and HAS-BLED scores were 4.6 ± 1.6 and 3.9 ± 1.0, respectively. Previous history of a major bleeding event was present in 37 patients (67.3%). Procedural success was achieved in 54 patients (98.2%). Device success was achieved in 100% of patients in whom device implantation was attempted (54 patients). Major in-hospital device-related complications included mortality of one patient (1.8%) and pericardial tamponade in two patients (3.6%); the incidence of stroke was 0%. No thrombus or significant leaks (≥5 mm) were observed on 1-month TEE. At 12 months, adverse events were overall death (1.8%), transient ischemic attack/ischemic stroke (1.8%), and major bleeding events (Bleeding Academic Research Consortium (BARC) 3a and 3c; 11%). In this high-risk population, the LAmbreTM device seems to be a safe and effective option for LAAC with a remarkable mid-term performance.
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Affiliation(s)
- Marc Llagostera-Martín
- Interventional Cardiology Unit, Cardiology Department, Hospital del Mar, 08003 Barcelona, Spain; (M.L.-M.); (H.C.-G.); (A.M.-S.); (N.S.); (A.S.-C.); (H.T.-M.); (M.G.-G.); (A.C.-F.); (L.M.)
| | - Hector Cubero-Gallego
- Interventional Cardiology Unit, Cardiology Department, Hospital del Mar, 08003 Barcelona, Spain; (M.L.-M.); (H.C.-G.); (A.M.-S.); (N.S.); (A.S.-C.); (H.T.-M.); (M.G.-G.); (A.C.-F.); (L.M.)
| | - Aleksandra Mas-Stachurska
- Interventional Cardiology Unit, Cardiology Department, Hospital del Mar, 08003 Barcelona, Spain; (M.L.-M.); (H.C.-G.); (A.M.-S.); (N.S.); (A.S.-C.); (H.T.-M.); (M.G.-G.); (A.C.-F.); (L.M.)
- Heart Diseases Biomedical Research Group (GREC), Hospital del Mar Medical Investigation Institute-IMIM, 08003 Barcelona, Spain
| | - Neus Salvatella
- Interventional Cardiology Unit, Cardiology Department, Hospital del Mar, 08003 Barcelona, Spain; (M.L.-M.); (H.C.-G.); (A.M.-S.); (N.S.); (A.S.-C.); (H.T.-M.); (M.G.-G.); (A.C.-F.); (L.M.)
| | - Andrea Sánchez-Carpintero
- Interventional Cardiology Unit, Cardiology Department, Hospital del Mar, 08003 Barcelona, Spain; (M.L.-M.); (H.C.-G.); (A.M.-S.); (N.S.); (A.S.-C.); (H.T.-M.); (M.G.-G.); (A.C.-F.); (L.M.)
| | - Helena Tizon-Marcos
- Interventional Cardiology Unit, Cardiology Department, Hospital del Mar, 08003 Barcelona, Spain; (M.L.-M.); (H.C.-G.); (A.M.-S.); (N.S.); (A.S.-C.); (H.T.-M.); (M.G.-G.); (A.C.-F.); (L.M.)
- Heart Diseases Biomedical Research Group (GREC), Hospital del Mar Medical Investigation Institute-IMIM, 08003 Barcelona, Spain
| | - Marcos Garcia-Guimaraes
- Interventional Cardiology Unit, Cardiology Department, Hospital del Mar, 08003 Barcelona, Spain; (M.L.-M.); (H.C.-G.); (A.M.-S.); (N.S.); (A.S.-C.); (H.T.-M.); (M.G.-G.); (A.C.-F.); (L.M.)
| | - Alicia Calvo-Fernandez
- Interventional Cardiology Unit, Cardiology Department, Hospital del Mar, 08003 Barcelona, Spain; (M.L.-M.); (H.C.-G.); (A.M.-S.); (N.S.); (A.S.-C.); (H.T.-M.); (M.G.-G.); (A.C.-F.); (L.M.)
| | - Luis Molina
- Interventional Cardiology Unit, Cardiology Department, Hospital del Mar, 08003 Barcelona, Spain; (M.L.-M.); (H.C.-G.); (A.M.-S.); (N.S.); (A.S.-C.); (H.T.-M.); (M.G.-G.); (A.C.-F.); (L.M.)
- Heart Diseases Biomedical Research Group (GREC), Hospital del Mar Medical Investigation Institute-IMIM, 08003 Barcelona, Spain
- Medicine Department, Autonomous University of Barcelona-UAB, 08193 Barcelona, Spain
| | - Beatriz Vaquerizo
- Interventional Cardiology Unit, Cardiology Department, Hospital del Mar, 08003 Barcelona, Spain; (M.L.-M.); (H.C.-G.); (A.M.-S.); (N.S.); (A.S.-C.); (H.T.-M.); (M.G.-G.); (A.C.-F.); (L.M.)
- Heart Diseases Biomedical Research Group (GREC), Hospital del Mar Medical Investigation Institute-IMIM, 08003 Barcelona, Spain
- Medicine Department, Autonomous University of Barcelona-UAB, 08193 Barcelona, Spain
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Schnupp S, Liu X, Buffle E, Gloekler S, Mohrez Y, Cheikh‐Ibrahim M, Allakkis W, Brachmann J, Park J, Kleinecke C. Late clinical outcomes of lambre versus amplatzer occluders for left atrial appendage closure. J Cardiovasc Electrophysiol 2020; 31:934-942. [DOI: 10.1111/jce.14398] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 02/02/2020] [Accepted: 02/06/2020] [Indexed: 12/24/2022]
Affiliation(s)
| | - Xiao‐Xia Liu
- Department of CardiologyThe 4th Hospital of Harbin Medical University Harbin China
- Department of CardiologyAnzhen Hospital, Capital Medical University Beijing China
| | - Eric Buffle
- Department of CardiologyUniversity Hospital of Bern Bern Switzerland
| | - Steffen Gloekler
- Department of CardiologyUniversity Hospital of Bern Bern Switzerland
- Department of CardiologySchwarzwald‐Baar Klinikum Villingen‐Schwenningen Germany
| | - Yamen Mohrez
- Department of CardiologyKlinikum Coburg Coburg Germany
| | | | | | | | - Jai‐Wun Park
- Department of CardiologyCharité Berlin‐University Medicine, Campus Benjamin Franklin Berlin Germany
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Ali M, Rigopoulos AG, Mammadov M, Torky A, Auer A, Matiakis M, Abate E, Bakogiannis C, Tzikas S, Bigalke B, Sedding D, Noutsias M. Systematic review on left atrial appendage closure with the LAmbre device in patients with non-valvular atrial fibrillation. BMC Cardiovasc Disord 2020; 20:78. [PMID: 32050904 PMCID: PMC7017553 DOI: 10.1186/s12872-020-01349-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 01/20/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Percutaneous closure (LAAC) of the left atrial appendage (LAA) is an efficacious preventive procedure for patients with non-valvular atrial fibrillation (NVAF) and considerable bleeding risk. We sought to systematically review the available LAAC data on the novel occluder device LAmbre™. METHODS For this systematic review, a search of the literature was conducted by 3 independent reviewers, reporting the safety and therapeutic success of LAAC in patients being treated with a LAmbre™. Publications reporting the safety and therapeutic success of LAAC using LAmbre™ in n > 5 patients were included. RESULTS The literature search retrieved n = 10 publications, encompassing n = 403 NVAF patients treated with a LAmbre™ LAAC, with relevant data regarding safety and therapeutic success of the procedure. The mean CHA2DS2-VASc Score was 4.0 + 0.9, and the mean HAS-BLED score was 3.4 + 0.5. The implantation success was 99.7%, with a mean procedure time of 45.4 ± 18.7 min, and a fluoroscopy time of 9.6 ± 5.9 min, and a contrast agent volume of 96.7 ± 0.7 ml. The anticoagulation regimen was switched to DAPT post procedure in the majority of the patients (96.8%). Partial and full recapture were done in 45.5% and in 25.6%, respectively. Major complications were reported in 2.9%, with 0.3% mortality, 1.7% pericardial tamponade, 0.3% stroke, and 0.6% major bleeding complications; no device embolization was observed. During follow up at 6 or 12 months, major adverse cardiovascular events were reported in 3.3%: Stroke or TIA in 1.7%, thrombus formation on the device in 0.7%, and residual flow > 5 mm in 1.0%. In some publications, the favorable implantion properties of the LAmbre™ for difficult anatomies such as shallow or multilobular LAA anatomies were described. CONCLUSIONS This systematic review on the LAmbre™ LAA-occluder including n = 403 NVAF patients demonstrates an excellent implantion success rate, promising follow-up clinical data, and favorable properties for also challenging LAA anatomies,. While its design seems to be helpful in preventing device embolization, pericardial tamponade may not be substantially reduced by the LAmbre™ as compared with other established LAAC devices. Further larger prospective multicenter registries and randomized trials are needed to scrutinize the value of the LAmbre™ compared with established LAAC devices.
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Affiliation(s)
- Muhammad Ali
- Mid-German Heart Center, Department of Internal Medicine III (KIM-III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany
| | - Angelos G Rigopoulos
- Mid-German Heart Center, Department of Internal Medicine III (KIM-III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany
| | - Mammad Mammadov
- Mid-German Heart Center, Department of Internal Medicine III (KIM-III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany
| | - Abdelrahman Torky
- Mid-German Heart Center, Department of Internal Medicine III (KIM-III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany
| | - Andrea Auer
- Mid-German Heart Center, Department of Internal Medicine III (KIM-III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany
| | - Marios Matiakis
- Mid-German Heart Center, Department of Internal Medicine III (KIM-III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany
| | - Elena Abate
- Mid-German Heart Center, Department of Internal Medicine III (KIM-III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany
| | - Constantinos Bakogiannis
- 3rd Department of Cardiology, Ippokrateio Hospital, Aristotle University of Thessaloniki, Konstantinoupoleos 49, 54642, Thessaloniki, Greece
| | - Stergios Tzikas
- 3rd Department of Cardiology, Ippokrateio Hospital, Aristotle University of Thessaloniki, Konstantinoupoleos 49, 54642, Thessaloniki, Greece
| | - Boris Bigalke
- Department of Cardiology, Charité, Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Daniel Sedding
- Mid-German Heart Center, Department of Internal Medicine III (KIM-III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany
| | - Michel Noutsias
- Mid-German Heart Center, Department of Internal Medicine III (KIM-III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany.
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