OBJECTIVES Left atrial appendage occlusion (LAAO) at the time of implantation may reduce thromboembolic events (TEs) during continuous-flow left ventricular assist device support. The HeartMate 3 (HM3) reduces TEs overall, but the efficacy of LAAO in HM3 is unknown. METHODS Adults receiving first HM3 implantation from November 2014 through December 2019 at a single, large medical centre were retrospectively reviewed. TEs included device thrombosis and ischaemic stroke. Patients were classified by whether they received LAAO or not. Incidence of TEs was compared between groups using cumulative incidence curves with competing risks (death and heart transplant) and risk factors for TEs were assessed with Fine and Gray competing risk regression. RESULTS A total of 182 patients received HM3, of whom 99 (54%) received LAAO versus 83 (46%) who did not. There were 14 TEs, including 13 strokes (7%) and 1 pump thrombosis (0.5%). No significant difference in the incidence of TEs in each group was found (Gray’s test: P = 0.35). LAAO was not associated with TEs in multivariable Fine–Gray analysis (P = 0.10) and no significant risk factors for TEs were found. There were zero disabling strokes in those who received LAAO compared to 6 (7%) in those who did not receive LAAO (P = 0.008). CONCLUSIONS A low number of TEs was observed in HM3 recipients. LAAO did not further reduce the overall rate of TEs in this patient population, though its use may be beneficial in preventing disabling ischaemic strokes after HM3 implantation.

中文翻译：

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左心耳封堵在 HeartMate 3 患者中的作用

目的 植入时左心耳闭塞 (LAAO) 可减少持续流动左心室辅助装置支持期间的血栓栓塞事件 (TE)。HeartMate 3 (HM3) 总体上降低了 TE，但 LAAO 在 HM3 中的功效尚不清楚。方法对 2014 年 11 月至 2019 年 12 月在单个大型医疗中心接受首次 HM3 植入的成年人进行回顾性审查。TE 包括装置血栓形成和缺血性卒中。患者根据是否接受 LAAO 进行分类。使用具有竞争风险（死亡和心脏移植）的累积发病率曲线比较组间 TE 的发生率，并使用 Fine 和 Gray 竞争风险回归评估 TE 的风险因素。结果 共有 182 名患者接受了 HM3，其中 99 名（54%）接受了 LAAO，而 83 名（46%）没有接受。有 14 例 TE，包括 13 例卒中 (7%) 和 1 例泵血栓形成 (0.5%)。未发现各组 TE 发生率有显着差异（格雷检验：P = 0.35）。在多变量 Fine-Gray 分析中，LAAO 与 TE 无关（P = 0.10），并且没有发现 TE 的显着危险因素。接受 LAAO 的患者致残性中风为零，而未接受 LAAO 的患者为 6 (7%) (P = 0.008)。结论 在 HM3 受者中观察到少量 TE。LAAO 并未进一步降低该患者群体中 TE 的总体发生率，尽管其使用可能有助于预防 HM3 植入后致残性缺血性中风。在多变量 Fine-Gray 分析中，LAAO 与 TE 无关（P = 0.10），并且没有发现 TE 的显着危险因素。接受 LAAO 的患者致残性中风为零，而未接受 LAAO 的患者为 6 (7%) (P = 0.008)。结论 在 HM3 受者中观察到少量 TE。LAAO 并未进一步降低该患者群体中 TE 的总体发生率，尽管其使用可能有助于预防 HM3 植入后致残性缺血性中风。在多变量 Fine-Gray 分析中，LAAO 与 TE 无关（P = 0.10），并且没有发现 TE 的显着危险因素。接受 LAAO 的患者致残性中风为零，而未接受 LAAO 的患者为 6 (7%) (P = 0.008)。结论 在 HM3 受者中观察到少量 TE。LAAO 并未进一步降低该患者群体中 TE 的总体发生率，尽管其使用可能有助于预防 HM3 植入后致残性缺血性中风。