First results of the Brazilian Registry of Percutaneous Left Atrial Appendage Closure.

Autor:	Guérios ÊE; Hospital Pilar, Curitiba, PR - Brasil., Chamié F; Hospital dos Servidores do Estado do Rio de Janeiro, Rio de Janeiro, RJ - Brasil., Montenegro M; Instituto Estadual de Cardiologia Aloysio de Castro (IECAC), Rio de Janeiro, RJ - Brasil., Saad EB; Hospital Pró-Cardíaco, Rio de Janeiro, RJ - Brasil., Brito FS Junior; Hospital Israelita Albert Einstein, São Paulo, SP - Brasil., Caramori PA; Centro de Pesquisa Cardiovasculares do Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS - Brasil., Simões LC; Instituto Nacional de Cardiologia (INC - MS), Rio de Janeiro, RJ - Brasil., Oliveira FRA; Instituto de Medicina Integral Prof. Fernando Figueira, Recife, PE - Brasil., Giuliano LC; SOS Cardio Serviços Hospitalares, Florianópolis, SC - Brasil., Tavares CMDF; Hospital São Vicente de Paulo, Rio de Janeiro, RJ - Brasil.; Rede D'Or, Rio de Janeiro, RJ - Brasil.
Jazyk:	English; Portuguese
Zdroj:	Arquivos brasileiros de cardiologia [Arq Bras Cardiol] 2017 Nov; Vol. 109 (5), pp. 440-447. Date of Electronic Publication: 2017 Oct 19.
DOI:	10.5935/abc.20170150
Abstrakt:	Background: Left atrial appendage closure (LAAC) is an effective alternative to oral anticoagulation (OA) for the prevention of stroke in patients with non-valvular atrial fibrillation (NVAF). Objective: To present the immediate results and late outcomes of patients submitted to LAAC and included in the Brazilian Registry of Percutaneous Left Atrial Appendage Closure. Methods: 91 patients with NVAF, high stroke risk (CHA2DS2VASc score = 4.5 ± 1.5) and restrictions to OAC (HAS-BLED score = 3.6 ± 1.0) underwent 92 LAAC procedures using either the Amplatzer cardiac plug or the Watchman device in 11 centers in Brazil, between late 2010 and mid 2016. Results: Ninety-six devices were used (1.04 device/procedure, including an additional non-dedicated device), with a procedural success rate of 97.8%. Associated procedures were performed in 8.7% of the patients. Complete LAAC was obtained in 93.3% of the successful cases. In cases of incomplete closure, no residual leak was larger than 2.5 mm. One patient needed simultaneous implantation of 2 devices. There were 7 periprocedural major (5 pericardial effusions requiring pericardiocentesis, 1 non-dedicated device embolization and 1 coronary air embolism without sequelae) and 4 minor complications. After 128.6 patient-years of follow-up there were 3 deaths unrelated to the procedure, 2 major bleedings (one of them in a patient with an unsuccessful LAAC), thrombus formation over the device in 2 cases (both resolved after resuming OAC for 3 months) and 2 strokes (2.2%). Conclusions: In this multicenter, real world registry, that included patients with NVAF and high thromboembolic and bleeding risks, LAAC effectively prevented stroke and bleeding when compared to the expected rates based on CHA2DS2VASc and HASBLED scores for this population. Complications rate of the procedure was acceptable considering the beginning of the learning curve of most of the involved operators.
Databáze:	MEDLINE
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