P1020Feasibility of pediatric probes in transesophageal echocardiography guiding of left atrial appendage closure in adults

Abstract

Abstract Introduction Transesophageal echocardiography (TEE) is essential in the guidance of left atrial appendage closure (LAAC). Current practice often requires general anesthetics (GA) to endure a standard size probe during LAAC procedures. Smaller probes for pediatric purposes have been developed and might be useful for the guidance of LAAC in adults, eliminating the need for general anesthetics (GA) and reducing procedure times. Methods In this prospective observational registry study patients were analyzed retrospectively to determine feasibility of pediatric TEE probes in adults for LAAC guidance. A standard set of LAA measurements, device compression and peri-device leakage was evaluated during procedure and by a second observer. Follow-up imaging, performed between 1–6 months after LAAC, was viewed by two independent reviewers for device positioning, peri-device leakage and thrombus formation. Results A total of 85 patients (56 male, mean age 72±7 years) were included. All patients underwent LAAC (76 Watchman, 9 Amplatzer Amulet), in 28 patients (33%) LAAC was combined with pulmonary vein isolation (PVI). The S8–3t micro-probe was used in 41 patients (48%) and the S7–3t mini-probe was used in 44 (52%). In 76 (38 mini-TEE, 38 micro-TEE) LAAC was successful, 7 of 9 failed procedures were due to unsuitable anatomy. Complete closure was achieved in 61/76 (80%, 29 mini-TEE, 32 micro-TEE), minimal residual flow was seen in 15/76 (20%, 8 mini-TEE, 7 micro-TEE). Device compression was comparable for mini- and micro-TEE and in accordance with recommendations. No GA was needed in 93% of the patients, none of these procedures were prematurely terminated because of discomfort. No serious probe related complications were seen. Follow-up imaging was performed 80±24 days after LAAC. Most patients (95%) underwent TOE with a standard probe for follow-up imaging, 5% of the patients underwent cardiac CT. Follow-up imaging showed similar proportions of patients with complete LAA closure (74%) or minimal residual flow (23%), while 2 patients had significant peri-device flow: 1 due to significant change in device position and 1 due to increase of peri-device leakage present during implant. In 1 patient device-related thrombus was seen and in 1 patient device embolization to the abdominal aorta occurred. Conclusions The use of pediatric probes in the guidance for LAAC in adults is a safe, effective, and attractive alternative avoiding the need for general anesthesia.