138-02: One-year permeability rate of LAA closure devices : high incidence of peridevice leak and lack of endothelialization

Abstract

Purpose: Percutaneous occlusion of the left atrial appendage (LAAO) is an alternative for patients with atrial fibrillation (AF) and contraindication to anticoagulants. Very few data are available in man regarding the residual permeability rate and endothelialization of implants, both conditions that may be associated to persistent embolic risk. The objectives of this study were to assess and compare the residual permeability rate by CT-scan and transesophageal echocardiography (TEE)in order to determine the causes of this permeability: peri-device leak or delayedendothelialization. Methods: Thirty-five patients were prospectively included in two French lefts (CHU Montpellier and Nimes) from July 2013 to April 2015. The judgments criteria were permeability of LAA at 12 months (contrast enhancement on CT-scan and color flow on TEE); presence of peri-device leak; endothelialization of the prosthesis. The permeability rate was compared in both type of prosthesis Watchman and Amplatzer Cardiac Plug (ACP), Summary: Patients had a mean age of 74.9 ± 6.4 years with a CHA2DS2-VASC score of 4.3 ± 1.4. The permeability rate on CT-scan at 10 ± 6 months was 70% (n = 21). Among them, a peri-device leak was noted in 5 patients (24%). Endothelialization at least partial was present in 19 (63.3%) patients. Sensitivity of TEE to diagnose permeability was 90.48% and specificity 88.89% compared to CT-scan. The LAA permeability rate on CT-scan was 83.33% for Watchman device, 61.11% for ACP (p = 0.1468). Conclusion: Our study shows that over a 10 ± 6 month-follow-up after LAAO, the LAA remains permeable in 70% of patients on CT-scan. In most cases the cause seems to be delayed endothelialization, only 24% of these patients have peri-device leak. Clinical implications are still unknown and new imaging processing techniques remain to be developed in order to provide a more accurate evaluation of the endothelialization process.