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Residual leaks following percutaneous left atrial appendage occlusion and outcomes: a meta-analysis

医学 心房颤动 左心耳阻塞 附属物 心耳 心脏病学 闭塞 内科学 经皮 荟萃分析 残余物 解剖 华法林 窦性心律 计算机科学 算法
作者
Athanasios Samaras,Αndreas S. Papazoglou,Charalampos Balomenakis,Αlexandra Bekiaridou,Dimitrios V. Moysidis,Vasiliki Patsiou,Antonios Orfanidis,George Giannakoulas,George Kassimis,Nikolaos Fragakis,Jacqueline Saw,Ulf Landmesser,Mohamad Adnan Alkhouli,Apostolos Tzikas
出处
期刊:European Heart Journal [Oxford University Press]
卷期号:45 (3): 214-229 被引量:23
标识
DOI:10.1093/eurheartj/ehad828
摘要

Abstract Background and Aims Residual leaks are not infrequent after left atrial appendage occlusion. However, there is still uncertainty regarding their prognostic implications. The aim of this study is to evaluate the impact of residual leaks after left atrial appendage occlusion. Methods A literature search was conducted until 19 February 2023. Residual leaks comprised peri-device leaks (PDLs) on transoesophageal echocardiography (TEE) or computed tomography (CT), as well as left atrial appendage patency on CT. Random-effects meta-analyses were performed to assess the clinical impact of residual leaks. Results Overall 48 eligible studies (44 non-randomized/observational and 4 randomized studies) including 61 666 patients with atrial fibrillation who underwent left atrial appendage occlusion were analysed. Peri-device leak by TEE was present in 26.1% of patients. Computed tomography-based left atrial appendage patency and PDL were present in 54.9% and 57.3% of patients, respectively. Transoesophageal echocardiography-based PDL (i.e. any reported PDL regardless of its size) was significantly associated with a higher risk of thromboembolism [pooled odds ratio (pOR) 2.04, 95% confidence interval (CI): 1.52–2.74], all-cause mortality (pOR 1.16, 95% CI: 1.08–1.24), and major bleeding (pOR 1.12, 95% CI: 1.03–1.22), compared with no reported PDL. A positive graded association between PDL size and risk of thromboembolism was noted across TEE cut-offs. For any PDL of >0, >1, >3, and >5 mm, the pORs for thromboembolism were 1.82 (95% CI: 1.35–2.47), 2.13 (95% CI: 1.04–4.35), 4.14 (95% CI: 2.07–8.27), and 4.44 (95% CI: 2.09–9.43), respectively, compared with either no PDL or PDL smaller than each cut-off. Neither left atrial appendage patency, nor PDL by CT was associated with thromboembolism (pOR 1.45 and 1.04, 95% CI: 0.84–2.50 and 0.52–2.07, respectively). Conclusions Peri-device leak detected by TEE was associated with adverse events, primarily thromboembolism. Residual leaks detected by CT were more frequent but lacked prognostic significance.
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