Abstract
Background
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.
Methods
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.
Results
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.
Conclusions
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.
Résumé
Introduction
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.
Méthodes
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.
Résultats
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.
Conclusions
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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Article info
Publication history
Published online: May 22, 2020
Accepted:
May 18,
2020
Received:
January 27,
2020
Footnotes
See page 456 for disclosure information.
Identification
Copyright
© 2020 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
