Long-term transesophageal echocardiography follow-up after percutaneous left atrial appendage closure.

Abstract

BACKGROUND\nPeri-device leaks and device thrombi are assumed to lead to ischemic events after percutaneous left atrial appendage occlusion (LAAO). While these device related complications are well assessed until 12 months after LAAO, no data are available beyond this period.\n\n\nOBJECTIVE\nTo assess device related complications beyond 12 months after LAAO.\n\n\nMETHODS\nAll patients who underwent successful percutaneous LAAO ≥ 12 months ago in the two participating centers were screened for eligibility. After inclusion a structured transesophageal echocardiography (TEE) was performed to assess peri-device leaks, device thrombus and other device related complications.\n\n\nRESULTS\nA total of 63 patients were enrolled into the present prospective two-center non-randomized single-arm trial. Median time from implantation until long-term TEE was 3.1 years (2.0 - 5.1) ranging from 1.0 to 7.5 years. The number of patients without detectable leak increased significantly at long-term TEE compared to the 6-week follow-up (p=0.04). Major peri-device leaks (> 5mm) were detected in 2 patients (3%). Device thrombus was found in 8 patients (13%). Patients with device thrombus at long-term follow-up had larger peri-device leaks at 6-week follow-up compared to those without thrombus formation (3.0 [2.7 - 3.5] vs. 1.4 [0.0 - 2.6]; p=0.04). Of those who suffered an ischemic stroke during long-term follow-up (n=5) one patient showed a peri-device leak >5mm. None of the patients with detected device thrombus developed a stroke.\n\n\nCONCLUSIONS\nPeri-device leaks and device thrombi continue to occur during long-term follow-up following LAAO. The clinical impact of these late occluder complications requires further evaluation in larger prospective trials.