Cierre percutáneo de la orejuela izquierda: eficacia, seguridad y nuevas perspectivas

Abstract

Esta tesis, presentada como compendio de publicaciones, estudia diversos aspectos relacionados con el cierre percutáneo de orejuela izquierda. Está técnica, de reciente introducción, permite mantener la protección frente a eventos cardioembólicos en pacientes con fibrilación auricular no valvular que no pueden tomar anticoagulación por algún motivo. La tesis doctoral analiza tanto aspectos más generales como la eficacia y seguridad de la técnica, como aspectos más técnicos relacionados con el análisis de las medidas de la orejuela, la selección del dispositivo de cierre y las futuras perspectivas con los dispositivos de segunda generación.

Left atrial appendage occlusion (LAAO) has emerged as a valid alternative to oral anticoagulation (OAC) in patients with atrial fibrillation and a relative/absolute contraindication to OAC. The present research explores some clinical, procedural and technical aspect of this novel interventional technique. The most important conclusions that can be extracted from our study and publications are the following: 1- ­‐ LAAO with the Amplatzer Cardiac Plug (ACP) system is a feasible and safe procedure with a low percentage of thrombo-­‐embolic events at follow-­‐up. After comparing the observed and estimated events according to the CHADS2 and CHA2DS2VASc scores for stroke and HASBLED for bleeding, LAAO seem to be associated with an important reduction of the thromboembolic and bleeding risk. 2- ­‐ There is an important variability in the angiographic and echocardiographic measurements of the LAA. Device oversizing does not seem to be associated with its compression once implanted. Device oversizing is however associated with a significant reduction of peri-­‐device leaks during echocardiopgraphic follow-­‐up. 3- ­‐ LAAO occlusion using the Amulet system seems to be feasible and safe in most of LAAs. Despite the absence of differences in procedural success and complications compared to ACP, the Amulet system is associated with a significant reduction of peri-­‐device leaks at follow-­‐up. The novel design features of Amulet seem to ease the procedure in complex anatomies.