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Percutaneous left atrial appendage closure using a novel occlusion device for thromboembolic prevention: 3-year procedural experience in a single high-volume center in Germany

https://doi.org/10.1007/s00392-024-02526-y

Fabian Moser (Hamburg)1, L. Rottner (Hamburg)1, I. My (Hamburg)2, M. Lemoine (Hamburg)2, D. Ismaili (Hamburg)1, P. Kirchhof (Hamburg)1, B. Reißmann (Hamburg)3, F. Ouyang (Hamburg)1, A. Metzner (Hamburg)2, A. Rillig (Hamburg)2

1Universitäres Herz- und Gefäßzentrum Hamburg Klinik für Kardiologie Hamburg, Deutschland; 2Universitäres Herz- und Gefäßzentrum Hamburg Klinik für Kardiologie mit Schwerpunkt Elektrophysiologie Hamburg, Deutschland; 3Universitäres Herz- und Gefäßzentrum Hamburg Allgemeine und Interventionelle Kardiologie Hamburg, Deutschland

 

Background

Stroke due to atrial fibrillation has been associated with a high risk of disability and mortality.

Percutaneous left atrial appendage (LAA) closure has been established as a treatment strategy for stroke prevention in patients not eligible for oral anticoagulation as well as in patients after electrical isolation of the LAA and subsequent increased risk of thrombus formation. The aim of this study was to evaluate the feasibility and initial experience of LAA closure using a novel nitinol-based, self-expanding system (LambreTM LAA Closure system) in an unselected patient cohort.

Methods and Results

 One hundred and two patients (39% female, median age 75 [71;80], median CHA₂DS₂-VASc score 5 [4;6]) underwent LAA closure with the novel system at the University Heart and Vascular Center, Hamburg between October 2020 and October 2023. 61/102 (61%) patients underwent previous electrical LAA isolation, 30/102 (29%) patients had high bleeding risk as an indication for LAA closure. Median procedure time was 45 [38;59] minutes and median fluoroscopy time was 10 [7;12] minutes. Successful LAA closure was achieved in all patients, despite different LAA anatomies. Median umbrella and cover disc diameter were 22 [20;24] millimeter and 28 [20;24] millimeter, respectively. Procedure-related adverse events occurred in 2/111 (1.8%) patients.  One patient had a vascular complication at the puncture site and another patient had non-hemodynamically significant pericardial effusion. Overall, the patients stayed for a median of 2 [1;4] days in hospital.

Conclusion

Left atrial appendage closure with a novel nitinol-based, self-expanding system is feasible and safe. LAA isolation was the most common indication for LAA closure at our institution. Further studies are needed, to identify differences and potential advantages of different LAA closure systems.

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