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Incomplete neo-endothelialization of left atrial appendage closure devices is frequent after 6 months: a pilot imaging study

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Abstract

Purpose: To bridge neo-endothelialization (NE) of implanted left atrial appendage closure (LAA/LAAC) devices, dual antiplatelet therapy is prescribed. Cardiac computed tomography angiography (cCTA) has been proposed for the evaluation of interventional LAAC. This prospective longitudinal observational study applied a standardized imaging protocol to detect progression of NE of LAAC devices 6 months after implantation. Methods: Consecutive cCTA datasets of patients six months after LAAC were acquired and the standardized multi-planar reconstruction LAA occluder view for post-implantation evaluation (LOVE) algorithm was used. Residual flow of contrast agent inside the LAA without a peri-device leak (PDL) was defined as incomplete neo-endothelialization. Absence of residual flow was defined as complete neo-endothelialization. Since PDL allows residual flow in the LAA, irrespective of neoendothelialization, PDL were excluded from this study. Diabetes mellitus, liver disease, body-mass-index, age, device sizes and type will be assessed as predictors for incomplete NE. Results: 53 consecutive patients were recruited for cCTA imaging. 36 (68%) showed no PDL and were included in the study (median age 77 years, 19% female). At median follow-up of 6 months (median 180 days, IQR 178–180), 44% of patients showed complete NE compared to 56% with NE still incomplete. Age, BMI, device type and size as well as prevalence of diabetes mellitus and liver disease did not show significant correlation with the completeness of NE. Conclusion: This pilot study showed that neo-endothelialization is still incomplete in a majority of patients at mid-term follow-up of 6 months after successful LAAC therapy. Further investigation on the consequences of incomplete endothelialization is needed to guide antiplatelet therapy schedules.

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Funding

This study was not supported by any funding.

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Author notes

  1. Simon Lindner and Michael Behnes have contributed equally to this study.

Authors and Affiliations

  1. First Department of Medicine, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany

    Simon Lindner, Michael Behnes, Annika Wenke, Benjamin Sartorius, Kathrin Julia Weidner, Uzair Ansari, Martin Borggrefe & Ibrahim Akin

  2. Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany

    Muharrem Akin

  3. Clinic for Cardiology and Angiology II, Universitaetszentrum Freiburg Bad Krozingen, University of Freiburg, Südring 15, 79189, Bad Krozingen, Germany

    Kambis Mashayekhi

  4. Institute of Clinical Radiology, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany

    Joshua Gawlitza, Holger Haubenreisser & Stefan O. Schoenberg

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  1. Simon Lindner
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  2. Michael Behnes
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  9. Uzair Ansari
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Corresponding author

Correspondence to Michael Behnes.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study has been approved by the Institutional Review Board (IRB).

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Lindner, S., Behnes, M., Wenke, A. et al. Incomplete neo-endothelialization of left atrial appendage closure devices is frequent after 6 months: a pilot imaging study. Int J Cardiovasc Imaging 37, 2291–2298 (2021). https://doi.org/10.1007/s10554-021-02192-5

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  • DOI: https://doi.org/10.1007/s10554-021-02192-5

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