| Abstract | Cilj istraživanja: Cilj istraživanja je prikazati indikacije i iskustvo KBC-a Split u
transkateterskoj okluziji aurikule lijevog atrija (LAAO), recentno odobrenoj za prevenciju
kardioembolijskih incidenata u pacijenata nepodobnih za dugoročnu primjenu oralnih
antikoagulansa (OAK).
Ispitanici i metode: Ispitivanje je uključilo 59 pacijenata, kojima je u periodu od 1. prosinca
2018. do 1. studenog 2022. godine indicirana LAAO procedura u KBC-u Split. Jedan je
pacijent isključen iz analize zbog proceduralno utvrđene kontraindikacije. Podaci su
prikupljeni u bolničkoj arhivi, BIS-u i anamnestički.
Rezultati: U analizu je uključeno 58 pacijenata s fibrilacijom atrija (FA) (dob: 73,9 ± 8,3
godina; 60,3% muškaraca; CHA2DS2-VASc = 4,7 ± 1,6; HAS-BLED = 2,4 ± 0,7). Ispitanici
su bili opterećeni kardiovaskularnim komorbiditetima i nosili velik teret FA. Primarne
indikacije za LAAO uključivale su krvarenje (intrakranijalno – 22,4%; gastrointestinalno –
34,5%; makrohematurija – 13,8%; epistaksa – 6,9%), sklonost krvarenju (3,4%) i moždani
udar na OAK-u (19,0%). Nije zabilježeno ozbiljnih proceduralnih komplikacija. Notirani su
manji perikardijalni izljevi (5,2%), arteriovenska fistula (1,7%) i hematom femoralne regije
(5,2%). Postproceduralno su opservirana 2 (3,4%) slučaja formiranja ugruška na površini
uređaja (DRT, engl. device related thrombus) uspješno liječena antikoagulantnom terapijom.
Najčešća postimplantacijska terapija bila je dvostruka antiagregacijska terapija (DAPT)
klopidogrelom tri mjeseca, potom acetil salicilna kiselina (ASK) tri mjeseca (65,5%),
odnosno tri mjeseca direktnih oralnih antikoagulansa (DOAK) s nastavnim ASK-om (10,3%).
Medijan praćenja za 93,1% pacijenata iznosio je 1,5 godina (IQR: 1,0 – 2,7). Zabilježeno je
3,7% kardiovaskularnih i 14,8% nekardiovaskularnih smrti. Krvarenje se javilo u 9,1%
pacijenata (medijan: 48 dana (min-max: 5 – 795)). 38,6% ispitanika bilo je bez terapije u
trenutku poziva.
Zaključak: Indikacije za LAAO odgovaraju dostupnim smjernicama. Interventni kardiološki
tim KBC-a Split provodi sigurne LAAO procedure, koje smanjuju stope krvarenja i
moždanog udara, a krivulja učenja nije utjecala na proceduralne ishode. Postimplantacijska
terapija varira kroz vrijeme u nedostatku jasnih smjernica za specifične kliničke situacije. |
| Abstract (english) | Objectives: This research aims to present the indications and experience of UH Split in
transcatheter left atrial appendage occlusion, recently approved for the prevention of
cardioembolic events in patients unsuitable for log-term oral anticoagulant (OAC) use.
Materials and methods: The study included 59 patients indicated for LAAO device
implantation between December 1st 2018 and November 1st 2020. Due to a procedurally
established contraindication one subject was excluded from further analysis. Data were
collected through the electronic health record database, hospital archive and patient
interviews.
Results: 58 patients with atrial fibrillation (AF) were included in the analysis (age: 73.9 ± 8.3
years; 60.3% men; CHA2DS2-VASc = 4.7 ± 1.6; HAS-BLED = 2.4 ± 0.7). Patients suffered
from multiple cardiovascular comorbidities and carried significant AF burden. Primary
indications for LAAO included bleeding (intracranial – 22.4%; gastrointestinal – 34.5%;
macrohematuria – 13.8%; epistaxis 6.9%), high bleeding risk (3.4%) and stroke on OAC
(19.0%). There were no major procedural complications. Minor pericardial effusions (5.2%),
arteriovenosus fistula (1.7%) and femoral hematoma (5.2%) were noted. Postprocedurally, 2
(3.4%) cases of device related thrombus (DRT) successfully treated with anticoagulant
therapy were observed. The most common therapy at discharge was double antiplatelet
therapy (DAPT) with clopidogrel for three months, followed by aspirin (ASA) for three
months (65.5%) or three months of direct oral anticoagulants (DOAC), then ASA long-term
(10.3%). Median follow-up of 93.1% of patients was 1.5 years (IQR: 1.0 – 2.7).
Cardiovascular and non-cardiovascular deaths were recorded in 3.7% and 14.8% of cases,
respectively. Bleeding occurred in 9.1% of patients (median: 48 days, range: 5 – 795). At the
time of the call, 38.6% of patients were off therapy.
Conclusions: Indications for LAAO correspond to available guidelines. The interventional
cardiology team of UH Split performs LAAO procedures safely, reducing the rates of
bleeding and stroke. Procedural outcomes were not affected by the learning curve.
Postimplantation therapy varies over time due to the absence of clear guidelines for specific
clinical situations. |
