Impact of Preprocedural Computed Tomography on Left Atrial Appendage Closure Success: A Swiss-Apero Trial Subanalysis

Roberto Galea; Adel Aminian; Nicolas Meneveau; Federico De Marco; Dik Heg; Frederic Anselme; Christoph Gräni; Adrian T Huber; Emmanuel Teiger; Xavier Iriart; Anna Franzone; Pascal Vranckx; Urs Fischer; Giovanni Pedrazzini; Francesco Bedogni; Marco Valgimigli; Lorenz Räber

doi:10.1016/j.jcin.2023.02.027

Impact of Preprocedural Computed Tomography on Left Atrial Appendage Closure Success: A Swiss-Apero Trial Subanalysis

JACC Cardiovasc Interv. 2023 Jun 12;16(11):1332-1343. doi: 10.1016/j.jcin.2023.02.027. Epub 2023 May 3.

Authors

Roberto Galea¹, Adel Aminian², Nicolas Meneveau³, Federico De Marco⁴, Dik Heg⁵, Frederic Anselme⁶, Christoph Gräni⁷, Adrian T Huber⁸, Emmanuel Teiger⁹, Xavier Iriart¹⁰, Anna Franzone¹¹, Pascal Vranckx¹², Urs Fischer¹³, Giovanni Pedrazzini¹⁴, Francesco Bedogni⁴, Marco Valgimigli¹⁵, Lorenz Räber¹⁶

Affiliations

¹ Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland. Electronic address: https://twitter.com/RobertoGalea7.
² Department of Cardiology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium.
³ Besancon University Hospital, University of Burgundy Franche-Comté, Besancon, France.
⁴ Department of Cardiology, Istituti di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, San Donato Milanese, Milan, Italy.
⁵ Department of Clinical Research, Clinical Trials Unit Bern, University of Bern, Bern, Switzerland.
⁶ Department of Cardiology, University Hospital of Rouen, Rouen, France.
⁷ Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland. Electronic address: https://twitter.com/chrisgraeni.
⁸ Department of Diagnostic, Interventional and Pediatric Radiology, Bern University Hospital, University of Bern, Bern, Switzerland.
⁹ Department of Cardiology, Henri-Mondor Hospital, Public Assistance Hospitals of Paris, Créteil, France.
¹⁰ Department of Pediatric and Adult Congenital Cardiology, Hôpital Cardiologique du Haut- Lévêque, Centre Hospitalier Universitaire de Bordeaux, Bordeaux-Pessac, France.
¹¹ Department of Advanced Biomedical Sciences, University Federico II University, Naples, Italy.
¹² Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis, Hasselt, Belgium; Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.
¹³ Department of Neurology, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Neurology, University Hospital Basel, University of Basel, Switzerland.
¹⁴ Cardiocentro Ticino Institute and Università della Svizzera Italiana, Lugano, Switzerland.
¹⁵ Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland; Cardiocentro Ticino Institute and Università della Svizzera Italiana, Lugano, Switzerland.
¹⁶ Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland. Electronic address: [email protected].

PMID: 37316145
DOI: 10.1016/j.jcin.2023.02.027

Abstract

Background: The benefit related to the use of preprocedural computed tomography angiography (CCTA) on top of periprocedural echocardiography to plan percutaneous left atrial appendage closure (LAAC) procedures is still unclear.

Objectives: The authors sought to evaluate the impact of preprocedural CCTA on LAAC procedural success.

Methods: In the investigator-initiated SWISS-APERO (Comparison of Amplatzer Amulet and Watchman Device in Patients Undergoing Left Atrial Appendage Closure) trial, patients undergoing echocardiography-guided LAAC were randomly assigned to receive the Amulet (Abbott) or Watchman 2.5/FLX (Boston Scientific) device across 8 European centers. According to the study protocol ongoing at the time of the procedure, the first operators had (CCTA unblinded group) or did not have (CCTA blinded group) access to preprocedural CCTA images. In this post hoc analysis, we compared blinded vs unblinded procedures in terms of procedural success defined as complete left atrial appendage occlusion as evaluated at the end of LAAC (short-term) or at the 45-day follow-up (long-term) without procedural-related complications.

Results: Among 219 LAACs preceded by CCTA, 92 (42.1%) and 127 (57.9%) were assigned to the CCTA unblinded and blinded group, respectively. After adjusting for confounders, operator unblinding to preprocedural CCTA remained associated with a higher rate of short-term procedural success (93.5% vs 81.1%; P = 0.009; adjusted OR: 2.76; 95% CI: 1.05-7.29; P = 0.040) and long-term procedural success (83.7% vs 72.4%; P = 0.050; adjusted OR: 2.12; 95% CI: 1.03-4.35; P = 0.041).

Conclusions: In a prospective multicenter cohort of clinically indicated echocardiography-guided LAACs, unblinding of the first operators to preprocedural CCTA images was independently associated with a higher rate of both short- and long-term procedural success. Further studies are needed to better evaluate the impact of preprocedural CCTA on clinical outcomes.

Trial registration: ClinicalTrials.gov NCT03399851.

Keywords: computed tomography angiography; left atrial appendage closure; procedural safety; procedural success.

Publication types

Randomized Controlled Trial
Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Atrial Appendage* / diagnostic imaging
Computed Tomography Angiography
Humans
Prospective Studies
Tomography, X-Ray Computed
Treatment Outcome

Associated data

ClinicalTrials.gov/NCT03399851