CE-452771-2 MANAGING PERI-DEVICE LEAKS AFTER LEFT ATRIAL APPENDAGE CLOSURE USING ENDOVASCULAR COILS AND/OR PLUGS

Abstract

Peri-device leak (PDL) after percutaneous LAA closure (LAAC) has been associated with an elevated risk for thromboembolism. PDL closure has been reported achievable using coils to obliterate the space behind the LAAC device, or elimination of the leak itself with a plug device. To present our center experience of PDL closure with endovascular coils or plugs in patients receiving LAAC between 2015 to 2022. We performed a retrospective chart review of patients who underwent PDL closure after LAAC with the Watchman or Watchman-FLX devices. After transeptal puncture, under ICE/TEE guidance, PDLs were closed with either endovascular coils (Terumo Inc) or plugs (Amplatzer, Abbott Inc), or a combination of both. We collected data on the number/size and method of PDL closure In total, the cohort included 45 pts: age 73±8.8 yrs, male 30 pts (67%), PAF 23 pts (51%), CHADS-VASc 4±1.5, HAS-BLED 2.8±1.1. The implanted device was Watchman in 34 pts and Watchman-FLX in 11 pts, with implant parameters: maximum LAA size 21±3.6 mm, LAAC device size 28±2.5 mm, and device compression 18%±5.1%. The PDL size was 3.9±1.5 mm (range 1.2 to 7 mm), and were identified at 12.4±14.3 mo post-implantation (range 2-72 mo). PDL closure was successful in 40 of 45 pts (89%) using coils alone in 21 of 40 pts (52.5%), plugs alone in 12 of 40 pts (30%), a combination in 6 of 40 pts (15%), and radiofrequency ablation in 1 pt (2.5%). For coils, an average of 4.6 coils were used. For plugs, an average of 1.2 plugs/pt were used (ADO2-11 pts, AVP2-7 pts, ASD-2 pts). The 5 PDL closure “failures” included: 1 aborted due to anatomic difficulty in accessing the leak, 3 aborted cases due to diminutive leak by invasive assessment, and 1 aborted due to pericardial effusion (percutaneously drained without sequalae). One pericardial effusion was successfully drained and the procedure successfully completed. Before PDL closure, over a mean follow-up of 38.5 mo post-LAAC, 7 ischemic strokes occurred (5.1%/100 pt-yr); but after PDL closure, there were no subsequent strokes. These data indicate that closure of PDLs with the use of either an endovascular coil, plug or a combination, is technically feasible in ∼90%, has a low procedural risk, and may reduce the risk of subsequent thromboembolism.