August 2, 2022BMC Cardiovascular DisordersOpen Access

Percutaneous left atrial appendage occlusion in a frail, high-risk, octogenarian patient population, after having undergone transcatheter aortic valve implantation

View Full Paper

Ask AI

Bookmark

Why the study?

The study aimed to evaluate the feasibility and safety of percutaneous LAAO in high-risk, frail patients who had undergone TAVI.

Does percutaneous left atrial appendage occlusion provide a feasible and safe stroke prevention method in frail, high-risk patients having undergone TAVI?

Structured PICO

Does percutaneous left atrial appendage occlusion provide a feasible and safe stroke prevention method in frail, high-risk patients having undergone TAVI?

Population

31 frail, high-risk, octogenarian patients with atrial fibrillation having undergone transcatheter aortic valve implantation (TAVI), with a history of bleeding, high bleeding risk (HAS-BLED), and chronic kidney disease with relative or absolute contraindication for NOACs. Mean age 82.1, 20 male / 11 female.

Intervention

Percutaneous left atrial appendage occlusion (LAAO) using WATCHMAN FLX or Amplatzer Amulet devices, performed 2-3 months after TAVI discharge.

Outcome

Feasibility and safety of percutaneous LAAO (successful implantation, major adverse cardiac events, major bleeding, acute kidney injury, stroke, device dislocation/embolization) up to discharge.safety

Percutaneous LAAO is a feasible and safe alternative for stroke prevention in frail, high-risk patients who have undergone TAVI and have contraindications to oral anticoagulation.

Limitations

relatively small, registry-based study
short follow-up time
does not allow any conclusions about the effectiveness of percutaneous LAAO in preventing cardioembolic stroke

Implication

LAAO post-TAVI feasible in small high-risk cohort; leaves open need for larger prospective trials before practice change.

Abstract

BACKGROUND: Percutaneous left atrial appendage occlusion (LAAO) represents an alternative stroke prevention method in patients with atrial fibrillation and an increased bleeding risk, chronic kidney disease or contraindications to oral anticoagulants. Aim of our study was to evaluate the feasibility and safety of percutaneous LAAO in high-risk, frail patients having undergone transcatheter aortic valve implantation (TAVI). METHODS: Thirty-one patients having undergone TAVI and scheduled for LAAO were prospectively included in our study. RESULTS: Implantation was successful in 29 of 31 cases (93.5%).There were no patients that developed a major acute cardiovascular event, stroke, or device dislocation/embolization. There was a single case of major bleeding (3.2%) and 3 cases of acute kidney injury (9.7%). At 3 months, no patients experienced a stroke, one patient had a device-related thrombus (3.4%), one patient showed a significant peri-device leak, and one patient had a persistent iatrogenic atrial septal defect. CONCLUSIONS: Our study shows that percutaneous LAAO may represent a feasible alternative strategy for stroke prevention, that can be safely performed in high-risk, multimorbid patients with high bleeding risk or contraindications to oral anticoagulation.