title: Left atrial appendage closure: A single center experience and comparison of two contemporary devices.
abstract: OBJECTIVE
  To compare indications and clinical outcomes of two contemporary left atrial appendage (LAA) percutaneous closure systems in a "real-world" population.
  
  
  BACKGROUND
  Percutaneous LAA occlusion is an emerging therapeutic option for stroke prevention in atrial fibrillation. Some questions however remain unanswered, such as the applicability of results of randomized trials to current clinical practice. Moreover, currently available devices have never been directly compared.
  
  
  METHODS
  We retrospectively analyzed consecutive patients who underwent LAA closure at San Raffaele Hospital, Milan, Italy between 2009 and 2015. Clinical indications and device selection were left to operators' decision; routine clinical and transesophageal echocardiography (TEE) follow-up was performed.
  
  
  RESULTS
  One-hundred and sixty-five patients were included in the study, of which 99 were treated with the Amplatzer Cardiac Plug (ACP) and 66 with the Watchman system. During the follow-up period (median 15 months, interquartile range 6-26 months) five patients died. The incidence of ischemic events was low, with one patient suffering a transient ischemic attack and no episodes recorded of definitive strokes. Twenty-six leaks ≥1 mm were detected (23%); leaks were less common with the ACP and with periprocedural three-dimensional TEE evaluation, but were not found to correlate with clinical events. Clinical outcomes were comparable between the two devices.
  
  
  CONCLUSIONS
  Our data show excellent safety and efficacy of LAA closure, irrespectively of the device utilized, in a population at high ischemic and hemorrhagic risk. The use of ACP and 3D-TEE minimized the incidence of residual leaks; however, the clinical relevance of small peri-device flow warrants further investigation. © 2016 Wiley Periodicals, Inc.
authors: Interventional Cardiology Department, San Raffaele Hospital, Milan, Italy.|EMO-GVM Centro Cuore Columbus, Milan, Italy.
authors: Filippo
authors: F
authors: Figini
authors: Interventional Cardiology Department, San Raffaele Hospital, Milan, Italy.
authors: Patrizio
authors: P
authors: Mazzone
authors: Interventional Cardiology Department, San Raffaele Hospital, Milan, Italy.
authors: Damiano
authors: D
authors: Regazzoli
authors: Interventional Cardiology Department, San Raffaele Hospital, Milan, Italy.
authors: Giulia
authors: G
authors: Porata
authors: Interventional Cardiology Department, San Raffaele Hospital, Milan, Italy.|EMO-GVM Centro Cuore Columbus, Milan, Italy.|Imperial College, London, United Kingdom.
authors: Neil
authors: N
authors: Ruparelia
authors: Interventional Cardiology Department, San Raffaele Hospital, Milan, Italy.|EMO-GVM Centro Cuore Columbus, Milan, Italy.
authors: Francesco
authors: F
authors: Giannini
authors: Interventional Cardiology Department, San Raffaele Hospital, Milan, Italy.
authors: Stefano
authors: S
authors: Stella
authors: Interventional Cardiology Department, San Raffaele Hospital, Milan, Italy.
authors: Francesco
authors: F
authors: Ancona
authors: Interventional Cardiology Department, San Raffaele Hospital, Milan, Italy.
authors: Eustachio
authors: E
authors: Agricola
authors: Interventional Cardiology Department, San Raffaele Hospital, Milan, Italy.
authors: Nicoleta
authors: N
authors: Sora
authors: Interventional Cardiology Department, San Raffaele Hospital, Milan, Italy.
authors: Alessandra
authors: A
authors: Marzi
authors: Interventional Cardiology Department, San Raffaele Hospital, Milan, Italy.
authors: Andrea
authors: A
authors: Aurelio
authors: Interventional Cardiology Department, San Raffaele Hospital, Milan, Italy.
authors: Nicola
authors: N
authors: Trevisi
authors: Interventional Cardiology Department, San Raffaele Hospital, Milan, Italy.
authors: Paolo
authors: P
authors: Della Bella
authors: Interventional Cardiology Department, San Raffaele Hospital, Milan, Italy.|EMO-GVM Centro Cuore Columbus, Milan, Italy.
authors: Antonio
authors: A
authors: Colombo
authors: Interventional Cardiology Department, San Raffaele Hospital, Milan, Italy.
authors: Matteo
authors: M
authors: Montorfano
mesh_terms: D000368:Aged; D020517:Atrial Appendage / Q000000981:diagnostic imaging / Q000601:surgery*; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D018618:Echocardiography, Doppler, Color; D019560:Echocardiography, Three-Dimensional; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D011474:Prosthesis Design; D012189:Retrospective Studies; D055989:Septal Occluder Device; D020521:Stroke / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D025321:Surgery, Computer-Assisted / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
keywords: antithrombotic agents; atrial fibrillation; stroke