Abstract 11766: Long Term Follow-up and Outcome of Atrial Fibrillation Patients With Left Atrial Appendage Obliteration Using Wireless Absorbable Occluders
Introduction: Metal occluders for the left atrial appendage (LAA) have been associated with morbidity that prevents their use as a primary approach for stroke prevention, in the majority of patients with atrial fibrillation(AF). Information on their long term outcome is limited. We hypothesize that a safe and effective occluder that reduces this morbidity with good long term outcome, could potentially replace anticoagulation in all patients with AF.
Methods: The Transcatheter Patch (TP) is an absorbable wireless device made by inflatable polyurethane. It was successfully implanted in the LAA for stroke prevention in 27/30 high risk for stroke patients (CHADS2 score>3) from 2005-2012. The patient age varied from 28-89 years and the LAA mouth diameter from 12-24 mm. No patient received supplemental anticoagulation. The patients were followed by transesophageal echocardiography (TEE) at 1 month, 6 months and one year. They had yearly clinical follow-ups, thereafter. The results along with the clinical outcome were analyzed.
Results: All 27 patients had uncomplicated implantation with full occlusion of the LAA. There was progressive decrease of the occluder size at 1 month (50% of the original), 6 months (20%) and one year (5%), maintaining the full occlusion. No new thromboembolic episodes, or other device related complications were noticed during the first year or in the subsequent clinical follow-up (max. 10, median 5 years). However, 4 deaths were noticed in this group for unrelated to AF causes (cancer, aortic aneurysm, renal failure etc).
Conclusion: It appears that the wireless absorbable occluder used succeeded in preventing thromboembolic episodes with no morbidity both on early and on long term follow-up. The occurence of several unrelated to the procedure deaths in this high risk group necessitates the performance of long term trials in a lower risk group of AF patients. Providing that the favorable acute and long term results are maintained, use of the TP device for LAA closure could be preferable to anticoagulation for stroke prevention, in patients who are currently not indicated for LAA closure.
Author Disclosures: E. Sideris: None. S. Toumanides: None. T. Agricola: None. S. Moulopoulos: None.
- © 2016 by American Heart Association, Inc.