Clinical Research| Volume 37, ISSUE 3, P450-457, March 2021

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Left-Atrial Appendage Thrombosis in Patients With Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Implantation



      Data 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.


      Retrospective 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.


      LAAT 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.


      LAAT 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.



      Les données sur les répercussions de la thrombose de l’appendice auriculaire gauche (TAAG) sur l’innocuité préliminaire et la mortalité des patients qui subissent une implantation valvulaire aortique par cathéter par la voie fémorale (IVAC-VF) sont rares. Notre objectif était d’examiner la prévalence et les prédicteurs de la TAAG et l’issue de cette maladie chez les patients traités par IVAC-VF.


      L’analyse rétrospective des données découlait d’un registre prospectif unicentrique sur l’innocuité préliminaire dans les 30 jours selon le Valve Academic Research Consortium-2 (VARC-2) et la mortalité dans les 2 ans entre les patients atteints de TAAG ou non atteints de TAAG.


      La TAAG était observée chez 7,6 % de la cohorte entière (n = 2527) et chez 16,6 % des patients atteints de fibrillation auriculaire (FA) préexistante connue (cohorte des patients atteints de FA, n = 1099). Comparativement aux témoins, les patients atteints de TAAG étaient plus malades, comme l’indiquaient le score plus élevé de la Society of Thoracic Surgeons (STS) et le fardeau des comorbidités. Ni l’innocuité préliminaire dans les 30 jours définie par le VARC-2 ni le taux d’accidents vasculaires cérébraux (AVC) n’étaient différents entre les patients atteints de TAAG et les témoins de la cohorte entière (innocuité préliminaire : 29,2 % vs 24,2 %, P = 0,123; AVC : 5,9 % vs 4,7 %, p = 0,495) et de la cohorte des patients atteints de FA (innocuité préliminaire : 29,1 % vs 22,9 %, p = 0,072; AVC : 5,6 % vs 3,3 %, p = 0,142). À l’analyse univariée de la cohorte entière, la mortalité en 2 ans était significativement plus élevée chez les patients atteints de TAAG que chez les témoins (rapport de risque, 1,41; intervalle de confiance à 95 %, 1,07-1,86; p = 0,014). Toutefois, l’analyse multivariée de la cohorte entière et de la cohorte de patients atteints de FA ne révélait aucune association entre les patients atteints de TAAG et la mortalité en 2 ans.


      La TAAG était fréquente chez les patients qui subissaient l’IVAC-VF, notamment les patients ayant des antécédents de FA, mais elle n’était pas associée à une augmentation des complications péri-interventionnelles et ne permettait pas de prédire la mortalité en 2 ans.
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