Pulmonary Ridge Coverage: A Two-edged Sword in Left Atrial Appendage Closure With LAmbre.

BACKGROUND

The LAmbre occluder, available in 2 versions, allows for selective coverage of the pulmonary ridge (PR) during left atrial appendage closure (LAAC). In this study we evaluated the effects of PR coverage on imaging and clinical outcomes in patients undergoing LAAC.

METHODS

Imaging data and clinical events were retrospectively analyzed for patients with nonvalvular atrial fibrillation who successfully underwent LAAC using the LAmbre device at the First Affiliated Hospital of Wenzhou Medical University between October 2018 and May 2022. The primary composite endpoint was thromboembolic (TE) events and device-related thrombus (DRT).

RESULTS

In total, 259 patients were evaluated using transesophageal echocardiography (TEE) at median intervals of 52 days (short term) and 385 days (long term). Patients were divided into a PR-covered group (n = 109) and a PR-uncovered group (n = 150). PR-uncovered patients showed a trend toward higher DRT incidence (8 of 150 vs 1 of 109, P = 0.056, log-rank test). The primary composite endpoint of TE events and DRT was significantly lower in the PR-covered group (14.0% vs 6.4%, P = 0.046, log-rank test). Any peridevice leak (PDL) was more frequent in the PR-covered group during both short-term (45.9% vs 28.7%, P = 0.004) and long-term (49.5% vs 25.3%, P < 0.001) follow-up, but no differences were observed for significant PDLs (> 3 mm). PR coverage was identified as an independent predictor of any long-term PDL (odds ratio 3.19, 95% confidence interval 1.64-6.18, P < 0.001).

CONCLUSIONS

PR coverage during LAAC with the LAmbre device was associated with a reduced risk of the primary composite endpoint of TE events and DRT, albeit with an increased incidence of nonsignificant PDL (≤ 3 mm).