The anatomy of the left atrial appendage (LAA) is highly variable. The four classical LAA shapes are windsock, chicken wing, cactus and cauliflower. In addition, a large double lobed LAA shape has been described, leading to 5 overall LAA morphologies. Precise assessment of the anatomical complexity and its influence on percutaneous LAA occlusion (LAAo) is crucial for procedural outcome.
Aims:
The aim of this study was to assess the impact of different LAA morphology types on the procedural characteristics of LAA occlusion and its impact on short-term clinical outcome.
Methods and Results:
A total of 115 consecutive patients (age 74 ± 11 years, 56% male, CHA2DS2VASc 4.6 ± 1.6, HASBLED 3.5 ± 0.9) undergoing LAAo with the Amplatzer Amulet device between 2014 and 2017 were included in the study. The morphology of the appendages was classified based both on angiographic and echocardiographic assessment. The most common LAA morphology was chicken wing (40.9%), of which 3.5% had a depth of the LAA neck ≤1.0 cm and were classified as “short neck chicken wing”, followed by windsock (27.8%), cactus (14.8%) and cauliflower (13.0%). A large double lobed LAA shape was found in only 4 (3.5%) patients. Regarding baseline characteristics and procedural success, there were no significant differences between the groups (p>0.05). The average fluoroscopy time was 10.5 ± 4.3 min, the mean radiation dose was 3104 ± 2125 cGy*cm2 and the mean amount of contrast agent used was 118.2 ± 51.2 ml. In patients with complex LAA anatomies, i.e. “short neck” chicken wing, cauliflower and double lobed LAA, fluoroscopy time (15.4 ± 5.8 min vs. 9.3 ± 2.8 min, p<0.001), radiation dose (4889 ± 2522 cGy*cm2 vs. 2657 ± 1764 cGy*cm2, p<0.001) and amount of contrast agent used (154.9 ± 49.4 ml vs. 109.0 ± 47.6, p<0.001). was significantly higher as compared to the other groups . The longest fluoroscopy time as well as the highest amount of contrast agent used was found in those patients with short neck chicken wing (19.3 ± 9.3 min, 167.5 ± 47.9 ml), followed by double lobulated LAA shape (15.4 ± 1.4 min, 141.3 ± 29.7 ml) and cauliflower morphology (14.3 ± 5.3 min, 155.2 ± 53.9 ml). Procedure related major adverse events, including major bleeding (2.6%), cardiac tamponade (0.9%) and pericardial effusion (0.9%), occurred in 5 patients and were not associated with specific anatomies.
Conclusion:
The anatomy of the LAA influences the complexity of the LAA occlusion procedure. Fluoroscopy time, radiation dose and amount of contrast agent used were significantly increased in patients with complex LAA anatomies, however proceduralsuccess and safety are seemingly not influenced by LAA morphology.
http://www.abstractserver.de/dgk2018/jt/abstracts//V854.htm