Institut Clinic Cardiovascular, Hospital Clinic de Barcelona, IDIBAPS, Barcelona, Spain.
Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada.
JACC Cardiovasc Interv. 2023 Sep 11;16(17):2139-2149. doi: 10.1016/j.jcin.2023.05.045. Epub 2023 Aug 9.
Device-related thrombus (DRT) remains one of the main concerns after left atrial appendage occlusion (LAAO). Several risk factors have been proposed, but most cannot be modulated. A modifiable factor such as device implantation depth is a potential target to adjust the risk for DRT.
The aim of this study was to assess the impact of LAAO device implantation depth as a predisposing factor for DRT.
The study included patients who underwent successful LAAO at 9 centers in Europe and Canada. Patients were classified into 2 groups: proximal device implantation (covered pulmonary ridge [PR] in the lobe and disc cohort or <5 mm from the PR in the single-lobe cohort) and distal device implantation (uncovered PR in the disc and lobe cohort and ≥5 mm in the single-lobe cohort).
A total of 1,317 patients were included. Among these, proximal and distal device implantation was achieved in 732 (55%) and 585 (45%) patients, respectively. No differences in procedural outcomes were observed between the groups. At follow-up, patients with proximal implantation had a lower incidence of DRT (2.3%) than those with distal implantation (12.2%) (P < 0.001). Deeper device implantation and a larger uncovered left atrial appendage area were associated with a higher incidence of DRT (P < 0.001), regardless of device type. In multivariable analysis, distal implant (HR: 5.92; 95% CI: 3.39-10.36) and no or single antiplatelet therapy (HR: 1.62; 95% CI: 0.99-2.62) emerged as independent predictors of DRT.
LAAO device implantation depth is an independent risk factor for DRT. Deeper device implantation and larger uncovered left atrial appendage areas were associated with a higher incidence of DRT.
左心耳封堵（LAAO）术后，器械相关血栓（DRT）仍然是主要关注点之一。已经提出了几个风险因素，但大多数因素无法调节。器械植入深度是一个可调节的因素，可能是调整 DRT 风险的目标。
本研究旨在评估 LAAO 器械植入深度作为 DRT 易患因素的影响。
该研究纳入了在欧洲和加拿大的 9 个中心成功接受 LAAO 的患者。患者被分为两组：近端器械植入（覆盖肺嵴[PR]在叶段和盘段，或在单叶段中距离 PR<5mm）和远端器械植入（未覆盖 PR 在盘段和叶段，或在单叶段中距离 PR≥5mm）。
共纳入 1317 例患者。其中，732 例（55%）和 585 例（45%）患者分别实现了近端和远端器械植入。两组之间的手术结果无差异。在随访期间，与远端植入组相比，近端植入组的 DRT 发生率较低（2.3% vs. 12.2%）（P<0.001）。更深的器械植入和更大的未覆盖左心耳面积与更高的 DRT 发生率相关（P<0.001），而与器械类型无关。多变量分析显示，远端植入（HR：5.92；95%CI：3.39-10.36）和无或单一抗血小板治疗（HR：1.62；95%CI：0.99-2.62）是 DRT 的独立预测因素。
LAAO 器械植入深度是 DRT 的独立危险因素。更深的器械植入和更大的未覆盖左心耳面积与 DRT 发生率升高相关。
