1. Predictors of Device-Related Thrombus Following Percutaneous Left Atrial Appendage Occlusion
- Author
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Fauchier, Grégoire, Bisson, Arnaud, Bodin, Alexandre, Herbert, Julien, Semaan, Carl, Angoulvant, Denis, Ducluzeau, Pierre Henri, Lip, Gregory, Fauchier, Laurent, Deharo, Pierre, Cuisset, Thomas, Lacour, Thibaud, Etienne, Christophe Saint, Jaussaud, Nicolas, Morera, Pierre, Spychaj, Jean-Charles, Porto, Alizée, Collart, Frederic, Theron, Alexis, Bernard, Anne, Bourguignon, Thierry, Simard, Trevor, Jung, Richard, Lehenbauer, Kyle, Piayda, Kerstin, Pracoń, Radoslaw, Jackson, Gregory, Flores-Umanzor, Eduardo, Faroux, Laurent, Korsholm, Kasper, Chun, Julian K.R., Chen, Shaojie, Maarse, Moniek, Montrella, Kristi, Chaker, Zakeih, Spoon, Jocelyn, Pastormerlo, Luigi, Meincke, Felix, Sawant, Abhishek, Moldovan, Carmen, Qintar, Mohammed, Aktas, Mehmet, Branca, Luca, Radinovic, Andrea, Ram, Pradhum, El-Zein, Rayan, Flautt, Thomas, Ding, Wern Yew, Sayegh, Bassel, Benito-González, Tomás, Lee, Oh-Hyun, Badejoko, Solomon, Paitazoglou, Christina, Karim, Nabeela, Zaghloul, Ahmed, Agrawal, Himanshu, Kaplan, Rachel, Alli, Oluseun, Ahmed, Aamir, Suradi, Hussam, Knight, Bradley, Alla, Venkata, Panaich, Sidakpal, Wong, Tom, Bergmann, Martin, Chothia, Rashaad, Kim, Jung-Sun, Pérez de Prado, Armando, Bazaz, Raveen, Gupta, Dhiraj, Valderrabano, Miguel, Sanchez, Carlos, El Chami, Mikhael, Mazzone, Patrizio, Adamo, Marianna, Ling, Fred, Wang, Dee Dee, O’neill, William, Wojakowski, Wojtek, Pershad, Ashish, Berti, Sergio, Spoon, Daniel, Kawsara, Akram, Jabbour, George, Boersma, Lucas V.A., Schmidt, Boris, Nielsen-Kudsk, Jens Erik, Rodés-Cabau, Josep, Freixa, Xavier, Ellis, Christopher, Demkow, Marcin, Sievert, Horst, Main, Michael, Hibbert, Benjamin, Holmes, David, Alkhouli, Mohamad, Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), CHU Trousseau [Tours], Éducation Éthique Santé EA 7505 (EES), Université de Tours (UT), EA4245 - Transplantation, Immunologie, Inflammation [Tours] (T2i), University of Liverpool, Aalborg University [Denmark] (AAU), Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research (C2VN), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Hôpital de la Timone [CHU - APHM] (TIMONE), Nutrition, obésité et risque thrombotique (NORT), Institut National de la Recherche Agronomique (INRA)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Marseille, Département de Cardiologie [Hôpital de la Timone - APHM], Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital de la Timone [CHU - APHM] (TIMONE), Institut de neurophysiopathologie (INP), Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), University of Ottawa [Ottawa], Université Laval [Québec] (ULaval), National Institute for Research and Development in Microtechnologies (IMT-Bucharest), Graduate School, Cardiology, and ACS - Heart failure & arrhythmias
- Subjects
Male ,Cardiac Catheterization ,Time Factors ,Percutaneous ,left atrial appendage occlusion ,Septal Occluder Device ,medicine.medical_treatment ,Transesophageal ,[SHS]Humanities and Social Sciences ,Pulmonary vein ,Postoperative Complications ,Risk Factors ,Interquartile range ,Atrial Fibrillation ,Registries ,Embolization ,ComputingMilieux_MISCELLANEOUS ,Watchman ,Incidence ,Atrial fibrillation ,Europe ,Survival Rate ,Treatment Outcome ,Echocardiography ,Cardiology ,Female ,Watchman FLX ,Cardiology and Cardiovascular Medicine ,medicine.medical_specialty ,Heart Diseases ,ACP ,Amplatzer cardiac plug ,Amulet ,DRT ,LAAO ,device-related thrombus ,Aged ,Atrial Appendage ,Echocardiography, Transesophageal ,Follow-Up Studies ,Humans ,Thrombosis ,Left atrial appendage occlusion ,Internal medicine ,medicine ,Risk factor ,Thrombus ,business.industry ,medicine.disease ,business - Abstract
Background: Device-related thrombus (DRT) has been considered an Achilles’ heel of left atrial appendage occlusion (LAAO). However, data on DRT prediction remain limited. Objectives: This study constructed a DRT registry via a multicenter collaboration aimed to assess outcomes and predictors of DRT. Methods: Thirty-seven international centers contributed LAAO cases with and without DRT (device-matched and temporally related to the DRT cases). This study described the management patterns and mid-term outcomes of DRT and assessed patient and procedural predictors of DRT. Results: A total of 711 patients (237 with and 474 without DRT) were included. Follow-up duration was similar in the DRT and no-DRT groups, median 1.8 years (interquartile range: 0.9-3.0 years) versus 1.6 years (interquartile range: 1.0-2.9 years), respectively (P = 0.76). DRTs were detected between days 0 to 45, 45 to 180, 180 to 365, and >365 in 24.9%, 38.8%, 16.0%, and 20.3% of patients. DRT presence was associated with a higher risk of the composite endpoint of death, ischemic stroke, or systemic embolization (HR: 2.37; 95% CI, 1.58-3.56; P < 0.001) driven by ischemic stroke (HR: 3.49; 95% CI: 1.35-9.00; P = 0.01). At last known follow-up, 25.3% of patients had DRT. Discharge medications after LAAO did not have an impact on DRT. Multivariable analysis identified 5 DRT risk factors: hypercoagulability disorder (odds ratio [OR]: 17.50; 95% CI: 3.39-90.45), pericardial effusion (OR: 13.45; 95% CI: 1.46-123.52), renal insufficiency (OR: 4.02; 95% CI: 1.22-13.25), implantation depth >10 mm from the pulmonary vein limbus (OR: 2.41; 95% CI: 1.57-3.69), and non-paroxysmal atrial fibrillation (OR: 1.90; 95% CI: 1.22-2.97). Following conversion to risk factor points, patients with ≥2 risk points for DRT had a 2.1-fold increased risk of DRT compared with those without any risk factors. Conclusions: DRT after LAAO is associated with ischemic events. Patient- and procedure-specific factors are associated with the risk of DRT and may aid in risk stratification of patients referred for LAAO.
- Published
- 2021