Page 42 - Journal of Structural Heart Disease Volume 4, Issue 2

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Meeting Abstracts
Methods and Results: Among 85 consecutive patients undergoing LAAO in our center since 2009, 10 of them had prior valvular surgery (2 surgical bioprostheses, 2 TAVI and 6 valve repairs) at a median time of 1520 days. At baseline, the CHA2DS2-VASc score was signi cantly higher in patients with VAF (group 1 ; 5.6 ± 2.1) than in those with NVAF (group 2 ; 4.7 ± 1.4, p=0 .04), but the HASBLED was similar between groups 1 and 2 (3.8 ± 1.4 vs 3.4 ± 1.1 respectively, p=0.17). There were no di erence in procedural success (100 vs 97%) nor in the rate of periprocedural major adverse events (1 migration suc- cessfully snared in group 1 vs 2 tamponades treated successfully by pericardiocentesis in group 2). At follow-up (median time 312 vs 330 days respectively, p=NS), overall survival was 80% in group 1 vs 89% in group 2 (p= 0.33) with no death procedure- nor device-related; the rate of additional adverse events was similarly low between groups 1 and 2 : major bleedings (2 vs 3, p=0.10) and ischemic strokes (0 vs 3, p=1).
Conclusion: Our data suggest that LAAO for stroke prevention is fea- sible and safe among patients with valvular atrial brillation, at mid term follow-up.
TRANSCATHETER LEFT ATRIAL APPENDAGE OCCLUSION USING DIFFERENT DEVICES IN THE REAL LIFE: RESULTS OF THE BELGIAN REGISTRY
J. Kefer1, A. Aminian2, P. Vermeersch3, T. De Potter4, F. Stammen5, E. Benit6, W. Budts7, L. Missault8, B. Drieghe9, I. Buysschaert10, K.Cornelis11, J.-M. Herzet12, A. Guedes13, N. Debbas14, M. Rivero15, M. Lempereur16, S. Lochy17, R. Casado- Arroyo18, C. Laruelle19, P. Debruyne20, T. Ledent21
1 Cliniques Universitaires Saint-Luc, Brussels, Belgium; 2 Chu Charleroi, Charleroi, Belgium, 3 Middelheim Zna, Antwerp, Belgium; 4 Olv Ziekenhuis, Aalst, Belgium; 5 Az Delta Roeselare, Roeselare, Belgium; 6 Jessaziekenhuis, Hasselt, Belgium; 7 Gasthuisberg Uz Leuven, Leuven, Belgium; 8 Az Sint-Jan, Brugge, Belgium; 9 Uz Gent, Gent, Belgium; 10 Asz Aalst, Aalst, Belgium; 11 Marie Middelares, Gent, Belgium; 12 Chr Citadelle, Liège, Belgium; 13 Chu Ucl Namur, Yvoir, Belgium; 14 Chu St- Pierre, Bruxelles, Belgium; 15 Ziekenhuis Oost-Limburg, Genk, Belgium; 16 Chu Liège, Liège, Belgium; 17 Uzbrussel, Brussels, Belgium; 18 Erasme Ulb, Bruxelles, Belgium; 19 St-Luc Bouge, Bouge, Belgium; 20 Imelda Ziekenhuis, Bonheiden, Belgium; 21 Chu Tivoli, La Louvière, Belgium
Objectives: This study aimed at assessing the safety and e cacy at mid-term follow-up of left atrial appendage occlusion using di erent devices, in the real life in Belgium.
Methods and Results: Between June 2009 and November 2016, 457 consecutive patients (63% males, 75±12 yrs, CHA2DS2-VASc 4±0.6, HASBLED 3.5±0.7) undergoing left atrial appendage occlusion in 21 centers, were included in the study. Technical success was 97.1%. There were 19 periprocedural major adverse events (4.1%) including three death (0.6%), nine tamponnades (1.9%), four major bleedings (0.8%) and two device embolizations (0.4%). The procedural outcome was similar between patients implanted with the Watchman device (N = 139) and those treated with the ACP/Amulet prosthesis (N = 318).
Among patients successfully implanted with a complete follow-up (672 patient-years, median follow-up 1273 days), the actual annual stroke rate was 1.2%, lower than the expected stroke risk (4%, 70%
reduction). The observed bleeding rate was 2%, while the calculated risk was 3.7% (46% reduction).
Kaplan-Meier analysis showed a similar overall survival (91±3% and 87±4% versus 93±2% and 87±3% ; p = 0.35) and event-free survival (88±3% and 80±5% versus 92±2% and 84±3% ; p = 0.17) at 1 and 2 years, for the Watchman versus the ACP/Amulet groups of patients, respectively.
At last follow-up, 90% of patients were left untreated by any antico- agulants: medication was limited to aspirin in 65% or to nothing in 5.7% of cases.
Conclusions: The data of the Belgian left atrial appendage occlusion registry suggest that the procedure is safe and e ective in a real world setting, to prevent atrial brillation-related thromboembolism at mid-term follow-up, using either the Watchman or the ACP/Amulet device.
PERCUTANEOUS CLOSURE OF LAA IN A PATIENTE WITH COR TRIATRIATUM
Laura Lanzoni1, Giulio Molon2, Guido Canali3, Stefano Bonapace4, Enrico Barbieri5
1 Ospedale Sacro-Cuore Don Calabria; Ospedale Sacro-Cuore Don Calabria; Ospedale Sacro-Cuore Don Calabria, 2 Cardiology Division, Sacro Cuore Hospital; Interventional; Adult Cardiology, 3 Ist. S.Cuore Don Calabria; Interventional; Adult Cardiology, 4 Ospedale Sacro- Cuore Don Calabria; Ospedale Sacro Cuore- Don Calabria; Ospedale Sacro Cuore- Don Calabria, 5 Ospedale Sacro-Cuore Don Calabria; Invasive Cardiology; Adult Cardiology
Background: Cor triatriatum(CTT)is a rare congenital heart disease (incidence 0,1-0,4%) in which the left atrium is divided into parts by a bromuscular membrane. The postero-superior portion receives venous blood, whereas the anterior-inferior part is in contact with mitral valve, fossa ovalis and left atrial appendage (LAA). The mem- brane is attached laterally to the junction of the left upper pulmonary vein and LAA, medially to the interatrial septum above the fossa ova- lis. CTT could be associated with other cardiac defects for example LSVC, ASD or anomalous venous return. This type of disease can be very severe in infancy mimic mitral stenosis or have a late presenta- tions related to other cardiac conditions such as mitral regurgitation or atrial brillation (AF).
History: We report a case of a patients (woman, 47 years) with CTT with large unrestrictive communications between the two chambers and small ostium secundum atrial septal defect. She was referred to our echolab for evaluation for LAA percutaneous closure as a bearer of permanent AF and Cooley’s disease (CHA2-DS2-VASC:2, HAS- BLED:4). The latter condition is an absolute contraindication for oral anticoagulation.
Imaging: RT2D/3D TEE clearly shows the absence of clots, the LAA anatomy: cauli ower like, the anatomical relationships between the membrane and surrounding structures and the interatrial septum in detail.
Indication for intervention: we decides to use the Watchman device (n.21, Boston Scienti c) for the presence of the membrane just above
Hijazi, Z
2017 LAA CSI Focus Abstracts