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Computed Tomography-Based Selection of Transseptal Puncture Site for Percutaneous Left Atrial Appendage Closure

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@article{023dbec9bcdd4510966d1d12b6a2e190,
title = "Computed Tomography-Based Selection of Transseptal Puncture Site for Percutaneous Left Atrial Appendage Closure",
abstract = "BACKGROUND: An inferoposterior transseptal puncture (TSP) is generally recommended for percutaneous left atrial appendage (LAA) closure. However, the LAA is a highly variable anatomical structure; this may impact the preferred TSP site.AIMS: This study aimed to determine the most optimal TSP site for percutaneous LAA closure in different LAA morphologies.METHODS: In this prospective study, 182 patients undergoing percutaneous LAA closure were included. The spatial relationship of the LAA to the fossa ovalis and its consequence for TSP was assessed at pre-procedural cardiac computed tomography (CCT).RESULTS: Based on CCT analysis, it was predicted that co-axial alignment between delivery sheath and LAA would be obtained by an inferoposterior, -central, or -anterior TSP in 75%, 16% and 8% of cases, respectively. This was also confirmed by procedural LAA angiogram in 175 cases (96%) with <30o angle between delivery sheath and LAA central axis. Multivariate logistic regression analysis identified reverse chicken wing LAA (Odds Ratio (OR) 6.36 [1.85-29.3]; P=0.005) and posterior bending of the proximal LAA (OR 17.2 [3.3-96.2]; P<0.001) as independent predictors of a central or anterior TSP - this to increase the chance of obtaining co-axial alignment between delivery sheath and LAA.CONCLUSIONS: An inferoposterior TSP is recommended in a majority of percutaneous LAA closure procedures in order to obtain co-axial alignment between delivery sheath and LAA. An inferior but more central/anterior TSP should be recommended in case of a reverse chicken wing LAA or posterior bending of the proximal LAA, which occurs in 20-25% of cases.",
author = "{De Backer}, Ole and Motoki Fukutomi and Andreas Fuchs and Gintautas Bieliauskas and Ivan Wong and Kofoed, {Klaus Fuglsang} and Lars S{\o}ndergaard",
year = "2021",
month = aug,
day = "31",
doi = "10.4244/EIJ-D-21-00555",
language = "English",
pages = "e--pub",
journal = "EuroIntervention",
issn = "1774-024X",
publisher = "Europa Edition",

}

RIS

TY - JOUR

T1 - Computed Tomography-Based Selection of Transseptal Puncture Site for Percutaneous Left Atrial Appendage Closure

AU - De Backer, Ole

AU - Fukutomi, Motoki

AU - Fuchs, Andreas

AU - Bieliauskas, Gintautas

AU - Wong, Ivan

AU - Kofoed, Klaus Fuglsang

AU - Søndergaard, Lars

PY - 2021/8/31

Y1 - 2021/8/31

N2 - BACKGROUND: An inferoposterior transseptal puncture (TSP) is generally recommended for percutaneous left atrial appendage (LAA) closure. However, the LAA is a highly variable anatomical structure; this may impact the preferred TSP site.AIMS: This study aimed to determine the most optimal TSP site for percutaneous LAA closure in different LAA morphologies.METHODS: In this prospective study, 182 patients undergoing percutaneous LAA closure were included. The spatial relationship of the LAA to the fossa ovalis and its consequence for TSP was assessed at pre-procedural cardiac computed tomography (CCT).RESULTS: Based on CCT analysis, it was predicted that co-axial alignment between delivery sheath and LAA would be obtained by an inferoposterior, -central, or -anterior TSP in 75%, 16% and 8% of cases, respectively. This was also confirmed by procedural LAA angiogram in 175 cases (96%) with <30o angle between delivery sheath and LAA central axis. Multivariate logistic regression analysis identified reverse chicken wing LAA (Odds Ratio (OR) 6.36 [1.85-29.3]; P=0.005) and posterior bending of the proximal LAA (OR 17.2 [3.3-96.2]; P<0.001) as independent predictors of a central or anterior TSP - this to increase the chance of obtaining co-axial alignment between delivery sheath and LAA.CONCLUSIONS: An inferoposterior TSP is recommended in a majority of percutaneous LAA closure procedures in order to obtain co-axial alignment between delivery sheath and LAA. An inferior but more central/anterior TSP should be recommended in case of a reverse chicken wing LAA or posterior bending of the proximal LAA, which occurs in 20-25% of cases.

AB - BACKGROUND: An inferoposterior transseptal puncture (TSP) is generally recommended for percutaneous left atrial appendage (LAA) closure. However, the LAA is a highly variable anatomical structure; this may impact the preferred TSP site.AIMS: This study aimed to determine the most optimal TSP site for percutaneous LAA closure in different LAA morphologies.METHODS: In this prospective study, 182 patients undergoing percutaneous LAA closure were included. The spatial relationship of the LAA to the fossa ovalis and its consequence for TSP was assessed at pre-procedural cardiac computed tomography (CCT).RESULTS: Based on CCT analysis, it was predicted that co-axial alignment between delivery sheath and LAA would be obtained by an inferoposterior, -central, or -anterior TSP in 75%, 16% and 8% of cases, respectively. This was also confirmed by procedural LAA angiogram in 175 cases (96%) with <30o angle between delivery sheath and LAA central axis. Multivariate logistic regression analysis identified reverse chicken wing LAA (Odds Ratio (OR) 6.36 [1.85-29.3]; P=0.005) and posterior bending of the proximal LAA (OR 17.2 [3.3-96.2]; P<0.001) as independent predictors of a central or anterior TSP - this to increase the chance of obtaining co-axial alignment between delivery sheath and LAA.CONCLUSIONS: An inferoposterior TSP is recommended in a majority of percutaneous LAA closure procedures in order to obtain co-axial alignment between delivery sheath and LAA. An inferior but more central/anterior TSP should be recommended in case of a reverse chicken wing LAA or posterior bending of the proximal LAA, which occurs in 20-25% of cases.

U2 - 10.4244/EIJ-D-21-00555

DO - 10.4244/EIJ-D-21-00555

M3 - Journal article

C2 - 34483092

SP - e-pub

JO - EuroIntervention

JF - EuroIntervention

SN - 1774-024X

ER -

ID: 68395376