title: Feasibility of Left Atrial Appendage Occlusion Without Preprocedural Transesophageal Echocardiography or CT Scanning.
abstract: OBJECTIVE
  To assess the success rate and safety outcomes of left atrial appendage occlusion (LAAO) procedures in a cohort of patients who had not undergone preprocedural imaging.
  
  
  BACKGROUND
  LAAO patients usually undergo imaging with either transesophageal echocardiography (TEE) or computed tomography (CT) prior to the procedure itself. This preprocedural imaging may not be necessary.
  
  
  METHODS
  The procedural success and major complication rates were assessed in a cohort of 52 patients who underwent LAAO without preprocedural imaging.
  
  
  RESULTS
  Mean patient age was 75 ± 8 years. Median CHA2DS2-VASc score was 4 and median HASBLED score was 3. The LAAO procedure was successful in 51/52 cases (98.1%). In 1 case, the LAAO procedure did not proceed because the LAA was too large for the available occlusion devices. No patient had left atrial appendage thrombus, despite the fact that only 4 patients were taking oral anticoagulation therapy at the time. Major complications occurred in 2/52 cases (3.8%), both due to vascular injuries causing pseudoaneurysm formation.
  
  
  CONCLUSIONS
  LAAO in this series was not adversely affected by lack of preprocedural imaging. Omitting preprocedural imaging reduces risk attributable to the modality, reduces patient inconvenience and discomfort, reduces cost, and does not appear to significantly reduce the proportion of patients who can undergo a successful procedure. Further larger studies are warranted.
authors.forename: Daniel
authors.initials: D
authors.lastname: Hammersley
authors.forename: Steven
authors.initials: S
authors.lastname: Podd
authors.forename: Ari
authors.initials: A
authors.lastname: Gomes
authors.forename: Catherine
authors.initials: C
authors.lastname: Thomson
authors.forename: Thomas
authors.initials: T
authors.lastname: Keeble
authors.forename: Maureen
authors.initials: M
authors.lastname: Dooley
authors.affiliation: Royal Sussex Cardiac Centre, Brighton Department of Cardiology, Brighton, BN2 5BE, United Kingdom. david.hildick-smith@bsuh.nhs.uk.
authors.forename: David
authors.initials: D
authors.lastname: Hildick-Smith
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020517:Atrial Appendage / Q000601:surgery*; D001281:Atrial Fibrillation / Q000601:surgery*; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D055989:Septal Occluder Device; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome