Safety and Efficacy of Mini-Invasive Left Atrial Appendage Closure: A Propensity-Score Analysis

Left atrial appendage closure (LAAC) for prevention of stroke is validated in patients with nonvalvular atrial fibrillation (NVAF) contraindicated to oral anticoagulation. General anaesthesia (GA) is often used for procedural guidance by transesophageal echocardiography (TEE); however, its use may be challenging in some patients. The aim of the study was to evaluate the safety and the midterm efficacy of a mini-invasive LAAC strategy using micro-TEE under procedural sedation. Comparison by propensity score of 2 cohorts of consecutive patients who underwent LAAC: standard TEE-guided LAAC (3-dimensional [3D] TEE under GA) and mini-invasive LAAC strategy (micro-TEE under procedural sedation). The primary endpoint was a composite of embolic or bleeding events, significant per procedural complication, and cardiovascular deaths within 3 months after LAAC. In total, 432 patients were included (78.7 ± 8 years old, 32.4% of women, CHA2DS2VASC score: 4.9 ± 1.1); 127 patients underwent mini-invasive LAAC strategy and were compared with 305 patients standard TEE-guided LAAC. The mini-invasive strategy was achieved in 122 of 127 (96.1%) planned patients. The primary endpoint occurred in 11.2% of patients from the mini-invasive LAAC strategy group and in 10.3% of patients from the standard TEE group (absolute difference = 0.9% [–6.4; 4.5], hazard ratio = 1.11 [0.56; 2.19], P = 0.76). Procedural times, fluoroscopy duration, and hospital stays were shorter in the mini-invasive LAAC strategy group (P < 0.001). The mini-invasive LAAC strategy is safe and effective compared with the standard TEE-guided LAAC strategy. A mini-invasive LAAC strategy may also be an important tool to help physicians to treat more patients as LAAC indications evolve in the future. La fermeture de l’appendice auriculaire gauche (AAG) pour prévenir les accidents vasculaires cérébraux a été validée chez des patients atteints de fibrillation auriculaire non valvulaire chez qui les anticoagulants oraux sont contre-indiqués. L’intervention se fait par échocardiographie transœsophagienne (ETO) et est souvent effectuée sous anesthésie générale, ce qui peut présenter des difficultés chez certains patients. Cette étude visait à évaluer l’innocuité et l’efficacité à moyen terme d’une fermeture de l’AAG minimalement invasive utilisant la micro-ETO effectuée sous sédation interventionnelle. Comparaison du score de propension de deux cohortes de patients consécutifs ayant subi une fermeture de l’AAG effectuée,