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.

中文翻译：

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经导管主动脉瓣植入的严重主动脉瓣狭窄患者的左心耳附件血栓形成

背景

缺乏关于经股动脉导管主动脉瓣植入术（TF-TAVI）的患者左心耳血栓形成（LAAT）对早期安全性和死亡率的影响的数据很少。我们旨在调查TF-TAVI治疗的患者中LAAT的患病率和预测因素以及与该病状相关的结果。

方法

回顾性数据分析来自前瞻性单中心注册表，根据Valve Academic Research Consortium-2（VARC-2）和2年死亡率比较，比较了有和没有LAAT的患者在30天时的早期安全性。

结果

在整个队列中，有7.6％的人发现LAAT（n = 2527），在已有已知房颤的患者中有16.6％的人发现LAAT（AF队列，n = 1099）。与对照组相比，LAAT患者病情较重，这是由胸外科医师协会（STS）评分较高和合并症负担所表明的。无论是VARC-2定义的30天早期安全性，还是LAAT与对照组的卒中发生率在总体上都没有差异（早期安全性：29.2％vs 24.2％，P  = 0.123；中风：5.9％vs 4.7％，P  = 0.495）和AF队列（早期安全性：29.1％vs 22.9％，P  = 0.072;中风：5.6％vs 3.3％，P = 0.142）。在单变量分析中评估整个队列，与对照组相比，LAAT的2年死亡率显着更高（危险比1.41； 95％置信区间1.07-1.86；P  = 0.014）。但是，对整个队列和AF队列的多变量分析显示，LAAT与2年死亡率之间没有关联。

结论

LAAT在接受TF-TAVI的患者中很常见，尤其是在有AF史的患者中，但与术中围手术期并发症的增加无关，并且不能预测2年死亡率。