Outcomes of Left Atrial Appendage Patency After Device Closure Detected by Cardiac CT: A Meta-Analysis.

Abstract

BACKGROUND Residual leaks are common after left atrial appendage occlusion (LAAO). OBJECTIVES The authors aimed to systematically evaluate the prognostic implications of residual left atrial appendage (LAA) patency and peridevice leaks (PDLs) detected by cardiac computed tomography (CT) following LAAO. METHODS The authors used traditional meta-analytical methods and a Bayesian framework to assess the probability of increased risks associated with these residual leaks. RESULTS Seventeen studies encompassing 2,036 patients met the inclusion criteria. During follow-up, the presence of any LAA patency was significantly associated with an almost 2-fold increased OR of thromboembolism (pooled OR: 1.87, 95% CI: 1.08-3.24), corresponding to 28 (95% CI: 3-68) additional events per 1,000 patients. Although PDL showed a similar trend, it was not significantly associated with increased thromboembolism risk (pooled OR: 1.50, 95% CI: 0.85-2.65). For thromboembolism with LAA patency, under a noninformative prior, the mean logOR was 0.59 (95% credible interval [Crl]: 0.06-1.15), and translated median OR of 1.87 (95% CrI: 1.06-3.14) and a mean absolute risk difference (ARD) of 2.8% (95% CrI: 0.2%-6.8%). The posterior probability of ARD >0% was 98.5%. For any PDL, the mean logOR was 0.38 (95% CrI: -0.22 to 0.95), with a median OR of 1.53 (95% CrI: 0.80-2.59) and mean ARD of 1.9% (95% CrI: -0.7% to 5.4%). The posterior probability of ARD >0% was 89.8%. CONCLUSIONS LAA patency and PDL identified by CT may be associated with an increased risk of thromboembolism. These findings indicate that residual leaks detected by CT may be clinically significant and should not be regarded as benign.