PO-01-083 PERCUTANEOUS CLOSURE OF PERI-DEVICE LEAK FOLLOWING LEFT ATRIAL APPENDAGE CLOSURE USING AN AMPLATZER DUCT OCCLUDER

Abstract

Percutaneous left atrial appendage (LAA) closure has been recognised as an alternative therapy for stroke prevention in selected patients with non-valvular atrial fibrillation (AF) who have difficulties with long-term oral anticoagulation. Peri-device leaks (PDLs) are frequently diagnosed after LAA closure procedures, regardless of closure methods. PDL > 5mm is related with further embolic events. Nevertheless, management of severe PDL has been a challenging concern which requires multiple teams involved. To report our single centre experiences of percutaneous closure of sever PDL using an Amplatzer closure device. Patients with PDL >5mm after the LAA closure at our centre were reviewed for secondary percutaneous closure. In a case-specific approach, an Amplatzer occluder was implanted under TEE and fluoroscopic guidance depending on the morphology of the defect. Patients' characteristics, procedural details and clinical outcomes was collected and analysed. Three patients (average age 67 ± 9 years old, 2 female) with severe PDL using either Watchman device (n=1) or Lariet device (n=2) were studied. The CHADs2VASC2 score was 4 ± 2, with HASBLED score of 4 ± 1. They all have multilobed LAA morphology (bi-lobar in 2 patients) and one patient suffered TIA in 6 weeks post LAA closure. PDLs with a neck size of 8.3 ± 2.9 mm (range 5-10 mm) were demonstrated on transoesophageal echocardiogram (TOE) and left atrium computed tomography. The percutaneous closure of PDLs were underwent at 10 ± 2 months after their LAA closure under general anaesthesia and TOE guidance. Three Amplatzer Duct Occluder II (ADO II) with an average size of 6.3 ± 0.2 mm were delivered to close the leaks successfully (Please see example cases in Figure 1). No peri-device residual flow was identified on TOE and LAA angiography after the secondary closure. No procedural complication occurred. There was no residual leak or peri-device thrombus formation on follow-up TOE in 60 days and anticoagulation was then stopped after the TOE confirmation. No further thromboembolic event was reported during an average follow-up of 9 ± 5months. Percutaneous closure of PDL using a tailored approach using ADO II device represents a safe, and feasible management associated with favourable clinical outcomes.