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Left trial appendage thrombosis in patients with severe aortic stenosis treated by transfemoral transcatheter aortic valve implantation
Authors : N Mangner (Dresden,DE), G Stachel (Leipzig,DE), F Woitek (Dresden,DE), L Crusius (Leipzig,DE), S Haussig (Dresden,DE), P Kiefer (Leipzig,DE), S Leontyev (Leipzig,DE), F Schlotter (Leipzig,DE), A Spindler (Leipzig,DE), R Hoellriegel (Dresden,DE), J Hommel (Dresden,DE), M Borger (Leipzig,DE), H Thiele (Leipzig,DE), D Holzhey (Leipzig,DE), A Linke (Dresden,DE)
N. Mangner1
,
G. Stachel2
,
F. Woitek1
,
L. Crusius2
,
S. Haussig1
,
P. Kiefer2
,
S. Leontyev2
,
F. Schlotter2
,
A. Spindler2
,
R. Hoellriegel1
,
J. Hommel1
,
M. Borger2
,
H. Thiele2
,
D. Holzhey2
,
A. Linke1
,
1Heart Center Dresden - Technical University of Dresden - Dresden - Germany
,
2University of Leipzig, Heart Center - Leipzig - Germany
,
Introduction: Data about the impact of left atrial appendage thrombosis (LAAT) on early safety and midterm mortality in patients undergoing transfemoral (TF) transcatheter aortic valve implantation (TAVI) are scarce.
Purpose: To investigate the incidence and predictors of LAAT as well as the outcome associated with this condition in a large cohort of patients treated by TF-TAVI.
Methods: Patients receiving TF-TAVI for native aortic valve stenosis or failed aortic bioprostheses were stratified according to the presence of LAAT diagnosed by transoesophageal echocardiography. Early safety at 30-days according to Valve Academic Research Consortium-2 (VARC-2) and 2-year all-cause mortality were the primary outcome measures.
Results: From 02/2006 to 06/2016, 2.527 patients (88.5%) out of 2.854 patients treated by TF-TAVI had an available transesophageal echocardiography (TEE) at baseline and formed the analysis cohort. LAAT was found in 7.6% of the whole cohort and in 16.6% in those patients with known pre-existing atrial fibrillation (AF cohort). Patients with LAAT appeared to be sicker compared to controls indicated by a higher 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: 24.2% vs. 29.2%, p=0.123; stroke: 4.7% vs. 5.9%, p=0.495) and AF cohort (early safety: 22.9% vs. 29.1%, p=0.072; stroke: 3.3% vs. 5.6%, p=0.142). Evaluating the whole cohort in a univariate analysis, the 2-year mortality was significantly higher in LAAT compared to controls (HR 1.41 [95% CI 1.07–1.86], p=0.014). However, a multivariate analysis of the whole cohort and a separate examination of the AF cohort revealed no association between LAAT and 2-year mortality.
Conclusion: LAAT was frequent in patients undergoing TF-TAVI, in particular in patients with a history of AF, but it was not associated with an increase in periprocedural complications. The fact that LAAT was no independent predictor of mortality indicates that it should be interpreted as a marker of an advanced disease stage rather than a prognostic factor.
