Left-Atrial Appendage Thrombosis in Patients With Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Implantation |
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| Authors: | Georg Stachel Felix J. Woitek Lisa Crusius Stephan Haussig Philipp Kiefer Sergey Leontyev Florian Schlotter Aileen Spindler Robert Höllriegel Jennifer Hommel Michael A. Borger Holger Thiele David Holzhey Axel Linke Norman Mangner |
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| Affiliation: | 1. Heart Center Leipzig at the University of Leipzig, Department of Cardiology, Leipzig, Germany;2. Herzzentrum Dresden, Technische Universität Dresden, Department of Internal Medicine and Cardiology, Dresden, Germany;3. Heart Center Leipzig–University Hospital, Department of Cardiac Surgery, Leipzig, Germany;1. Department of Cardiology, Amiens University Hospital, Amiens, France;2. UR UPJV 7517, Jules Verne University of Picardie, Amiens, France;3. Department of Cardiology, Hôpital de la Timone, Aix-Marseille University, Marseille University Hospital, Marseille, France;4. Department of Cardiology, Saint Quentin hospital, Saint Quentin, France;5. Department of Clinical Research, Amiens Picardy University Hospital, Amiens, France;1. Division of Interventional Radiology, Department of Radiology, Texas Children’s Hospital, Houston, Texas;2. Department of Interventional Radiology, St. Louis University Hospital, St. Louis, Missouri;3. Cancer and Hematology Centers, Texas Children’s Hospital, Houston, Texas;4. Division of Pediatric Surgery, Michael E. Debakey Department of Surgery, Baylor College of Medicine and Texas Children''s Hospital, Houston, Texas;1. CHRU Lille, Institut C?ur-Poumon - Bd du Professeur Jules Leclercq - CHU Lille, F59000-Lille, France;2. CHU Brabois, Vand?uvre-lès-Nancy, France;3. Universitaire Lille, CHU Lille, ULR 2694-METRICS: évaluation des technologies de santé et des pratiques médicales, Lille, France;4. L''Institut du Thorax, Cardiologic Department and Reference Center for Hereditary Arrhythmic Diseases INSERM 1087, Nantes, France |
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| Abstract: | BackgroundData about the impact of left-atrial appendage thrombosis (LAAT) on early safety and mortality in patients undergoing transfemoral transcatheter aortic valve implantation (TF-TAVI) are scarce. We aimed to investigate the prevalence and predictors of LAAT and the outcome associated with this condition in patients treated by TF-TAVI.MethodsRetrospective data analysis was derived from a prospective single-centre registry comparing patients with and without LAAT regarding early safety at 30 days, according to Valve Academic Research Consortium-2 (VARC-2) and 2-year mortality.ResultsLAAT was found in 7.6% of the whole cohort (n = 2527) and in 16.6% in those patients with known pre-existing atrial fibrillation (AF cohort, n = 1099). Compared with controls, patients with LAAT were sicker, indicated by a higher Society of Thoracic Surgeons (STS) score and burden of comorbidities. Neither VARC-2–defined early safety at 30 days nor the rate of stroke was different between LAAT and controls in both the whole (early safety: 29.2% vs 24.2%, P = 0.123; stroke: 5.9% vs 4.7%, P = 0.495) and AF cohort (early safety: 29.1% vs 22.9%, P = 0.072; stroke: 5.6% vs 3.3%, P = 0.142). Evaluating the whole cohort in a univariate analysis, the 2-year mortality was significantly higher in LAAT compared with controls (hazard ratio, 1.41; 95% confidence interval, 1.07-1.86; P = 0.014). However, multivariate analysis of the whole cohort and the AF cohort revealed no association between LAAT and 2-year mortality.ConclusionsLAAT was frequent in patients undergoing TF-TAVI— in particular, in patients with histories of AF—but it was not associated with an increase in periprocedural complications and did not predict 2-year mortality. |
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