Background

Left atrial appendage closure (LAAC) is considered a feasible alternative for stroke prevention in patients with atrial fibrillation and contraindication to oral anticoagulation. As impaired renal function is common in this cohort of patients, procedural approaches, merely guided by transesophageal echocardiography (TEE) and free of contrast-dye have been established before. However, data on contrast-free procedural results with the LAMBRE device are lacking and are the focus of this analysis.

Methods and results

The multicenter retrospective BoBoMa (Bonn/Bordeaux/Mainz)-Registry included a total of 78 patients that underwent LAAC with LAMBRE devices without the use of contrast-dye. Patients were at a mean age of 77.8±7.4 years with increased thromboembolic and bleeding risk (CHADS-VASc-score 4.7±1.4, HAS-BLED-score 3.6±0.9). Renal function was overall impaired with a mean serum creatinine of 1.7±1.2 mg/dl (GFR 47.8±22.2 ml/min). Device success was achieved in 77/78 (98.7%) of cases with repositioning of the occluder in 9.0% and resizing in 3.8% of cases. Mean procedural time was 46.7±33.7 min and a mean radiation dose of 4.91±5.78 Gy*cm². Achieved device position was satisfying in terms of occluder position and pericevice flow. Periprocedural complications occurred in 6/78 (7.7%) of cases, with only one major complication (device embolization). Other complications included minor pericardial effusion and vascular access site complications (2.6%, 2/78) of cases, Deriving from abovementioned complications, technical success was achieved in 77/78 (98.7%) of patients.

Conclusion

TEE-guided LAAC without use of contrast-dye appears to be save using LAMBRE devices. The overall outcome was satisfying with low complication rates and satisfying results regarding occluder positioning. Further prospective and direct comparison of devices is warranted in constrast-free TEE-guided LAAC.