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Amplatzer left atrial appendage closure: Single versus combined procedures
Author(s) -
Kleinecke Caroline,
Buffle Eric,
Link Juergen,
Häner Jonas,
Sedaghat Alexander,
Galea Roberto,
Streit Samuel R.,
Windecker Stephan,
Meier Bernhard,
Gloekler Steffen
Publication year - 2021
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.29271
Subject(s) - medicine , patent foramen ovale , atrial fibrillation , clinical endpoint , percutaneous , cardiology , stroke (engine) , surgery , single center , mitral regurgitation , atrial appendage , mitraclip , randomized controlled trial , sinus rhythm , mechanical engineering , engineering
Objectives This study compares procedural and late clinical outcomes of left atrial appendage closure (LAAC) with Amplatzer devices as a single versus a combined procedure with other structural or coronary interventions. Background Multiple cardiac conditions are frequent among elderly patients and invite simultaneous treatment to ensure a favorable patient outcomes. Methods 559 consecutive patients (73.3 ± 11.1 years) underwent LAAC with Amplatzer devices at two centres (Bern and Zurich university hospitals, Switzerland) either as a single procedure or combined with other interventions. The primary safety endpoint was a composite of major peri‐procedural complications and major bleeding at follow‐up, the primary efficacy endpoint included stroke, systemic embolism, and cardiovascular/unexplained death. All event rates are reported per 100 patient‐years. Results In 263 single and 296 combined procedures with percutaneous coronary interventions (47.6%), closure of an atrial septal defect (8.4%) or a patent foramen ovale (36.5%), transcatheter aortic valve implantation (10.1%), mitral clipping (4.1%), atrial fibrillation ablation (8.8%), or another procedure (3.0%) were analyzed. Device success (96.6% [single] vs. 99.0% [combined], p  = .08) did not differ between the groups. After a mean follow‐up of 2.6 ± 1.5 vs. 2.5 ± 1.5 years and a total of 1,422 patient‐years, the primary efficacy (40/677, 5.9% [single] vs. 37/745, 5.0% [combined]; HR, 1.2, 95% CI, 0.8–1.9, p  = .44), as well as the primary safety endpoint (25/677, 3.7% vs 28/745, 3.8%; HR, 1.0, 95% CI, 0.6–1.8, p  = .89) were comparable. Conclusions LAAC with Amplatzer devices combined with structural, coronary, and electrophysiological procedures offers procedural feasibility and safety, as well as long‐term efficacy.

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