Atrial appendage closure in patients with heart failure and atrial fibrillation: industry-independent single-centre study.

AIMS: To evaluate outcomes of percutaneous left atrial appendage closure (LAAC) in patients with congestive heart failure (CHF) and non-valvular atrial fibrillation (AF) in a consecutive, industry-independent registry associated with periprocedural success and complications during long-term follow-up. METHODS AND RESULTS: For this analysis, we included patients who underwent transcatheter LAAC from January 2014 to December 2019 at the University Heart Center in Lübeck, Germany, and compared patients with presence of CHF defined as patients with a reduced left ventricular ejection fraction (LVEF ≤ 40%), patients with a mid-range LVEF (LVEF 41-49%), patients with diastolic dysfunction and preserved LVEF (LVEF ≥ 50%), and patients with right-sided heart failure and impaired right ventricular function (tricuspid annular plane systolic excursion < 17) to patients undergoing LAAC with no CHF. Primary endpoints were defined as periprocedural complications, and complications during long-term follow-up presented as major adverse cardiac and cerebrovascular events (MACCE). A total of 300 consecutive patients underwent LAAC. Of these, 96 patients in the CHF group were compared with 204 patients in the non-CHF group. Implantation success was lower in CHF group in comparison with non-CHF group (99.5% vs. 96%, P = 0.038); otherwise, there were no differences in periprocedural complications between groups. Patients with CHF showed a significantly higher incidence of MACCE rate (31.9% vs. 15.1%, P = 0.002) and more deaths (24.2% vs. 7%, P ≤ 0.001) during long-term follow-up. In Cox multivariable regression analysis, CHF was an independent predictor of mortality after LAAC implantation at long-term follow-up (hazard ratio 3.23, 95% confidence intervals 1.52-6.86, P = 0.002). CONCLUSIONS: Implantation of LAAC devices in patients with non-valvular AF and CHF is safe. The increased mortality in patients with CHF compared with patients without CHF during the long-term follow-up is mainly attributed to comorbidities associated with CHF.

Short term outcome of thoracic endovascular aortic repair in patients with thoracic aortic diseases.

AIM AND BACKGROUND: Open surgical repair for thoracic aortic diseases is associated with a high perioperative mortality and morbidity. Most of type B aortic dissections are uncomplicated and are medically treated which carries a high mortality rate. Thoracic endovascular aortic repair is the first-line therapy for isolated aneurysms of the descending aorta and complicated type B aortic dissection. The aim of this study is to test the safety of early thoracic endovascular aortic repair in patients with uncomplicated type B aortic dissection and patients with thoracic aortic aneurysms. METHODS: A total of 30 patients (24 men and 6 females; mean age 59 ±â€¯8 years) with uncomplicated type B aortic dissection and descending thoracic aortic aneurysm who underwent endovascular aortic repair in National Heart Institute and Cairo University hospitals were followed up. Clinical follow-up data was done at one, three and twelve months thereafter. Clinical follow-up events included death, neurological deficits, symptoms of chronic mal-perfusion syndrome and secondary intervention. Multi-slice computed tomography was performed at three and six months after intervention. RESULTS: Of the 30 patients, 24 patients had aortic dissection, and 6 patients had an aortic aneurysm. 7 patients underwent hybrid technique and the rest underwent the basic endovascular technique in whom success rate was 100%. Two patients developed type I endoleak, however both improved after short term follow up. The total mortality rate was 10% throughout the follow-up. Both death and endoleak occurred in subacute and chronic cases, while using TEVAR in acute AD and aneurysm showed no side effects. Early thoracic endovascular aortic repair showed better results and less complications. CONCLUSION: Along with medical treatment, early thoracic endovascular aortic repair in uncomplicated type B aortic dissections and thoracic aortic aneurysms is associated with better outcome.