Long-term transesophageal echocardiography follow-up after percutaneous left atrial appendage closure.

BACKGROUND: Peri-device leaks and device thrombi are assumed to lead to ischemic events after percutaneous left atrial appendage occlusion (LAAO). While these device-related complications are well assessed until 12 months after LAAO, no data are available beyond this period. OBJECTIVE: The purpose of this study was to assess device-related complications beyond 12 months after LAAO. METHODS: All patients who underwent successful percutaneous LAAO ≥12 months ago in the 2 participating centers were screened for eligibility. After inclusion, structured transesophageal echocardiography (TEE) was performed to assess peri-device leaks, device thrombus, and other device-related complications. RESULTS: A total of 63 patients were enrolled in the present prospective, 2-center, nonrandomized, single-arm trial. The median time from implantation until long-term TEE was 3.1 years (interquartile range 2.0-5.1 years), ranging from 1.0 to 7.5 years. The number of patients without a detectable leak increased significantly at long-term TEE compared with 6-week follow-up (P = .04). Major peri-device leaks (>5 mm) were detected in 2 patients (3%). Device thrombus was found in 8 patients (13%). Patients with device thrombus at long-term follow-up had larger peri-device leaks at 6-week follow-up than did those without thrombus formation (3.0 [interquartile range 2.7-3.5] vs 1.4 [interquartile range 0.0-2.6]; P = .04). Of those who suffered an ischemic stroke during long-term follow-up (n = 5), 1 patient showed a peri-device leak >5 mm. None of the patients with detected device thrombus had a stroke. CONCLUSION: Peri-device leaks and device thrombi continue to occur during long-term follow-up after LAAO. The clinical impact of these late occluder complications requires further evaluation in larger prospective trials.

Reverse Cardiac Remodeling After Transcatheter Treatment of Severe Tricuspid Regurgitation Using the Edge-to-Edge MitraClip Technique.

OBJECTIVES: In recent years, transcatheter treatment techniques for tricuspid regurgitation (TR) have rapidly evolved. Cardiac remodeling analysis beyond clinical outcome assessment following transcatheter tricuspid repair is still lacking. The aim of the present case series was to analyze cardiac remodeling after tricuspid valve repair using the edge-to-edge MitraClip technique. METHODS: Echocardiographic analysis was performed prior to MitraClip implantation and at 3-month and 6-month follow-up exams. RESULTS: Six consecutive patients undergoing MitraClip implantation between April 2017 and March 2018 at our institution were enrolled. During follow-up, TR reduction was durable in all patients, without recurrence of severe TR. Compared to baseline, right ventricular function improved in 5 out of 6 patients. Reduction in right ventricular area was observed in the majority of patients and reduction in right atrial volume was observed in all subjects. Patients also experienced beneficial left cardiac remodeling. CONCLUSION: The present series indicates that transcatheter treatment of severe TR using the edge-to-edge MitraClip technique can lead to reverse cardiac remodeling, which is not commonly seen in surgically treated patients.