A decade later: long-term results of the first percutaneous epicardial closure of the left atrial appendage using the LARIAT device

Marian Burysz; Michalina Malec-Litwinowicz; Jakub Batko; Radoslaw Litwinowicz; Mariusz Kowalewski; Bogus Aw Kapelak; Krzysztof Bartus

doi:10.5114/kitp.2023.134176

A decade later: long-term results of the first percutaneous epicardial closure of the left atrial appendage using the LARIAT device

Kardiochir Torakochirurgia Pol. 2023 Dec;20(4):215-219. doi: 10.5114/kitp.2023.134176. Epub 2024 Jan 11.

Authors

Marian Burysz¹, Michalina Malec-Litwinowicz², Jakub Batko^{3

4}, Radoslaw Litwinowicz^{1

3

4}, Mariusz Kowalewski^{4

5

6}, Bogus Aw Kapelak⁷, Krzysztof Bartus⁷

Affiliations

¹ Department of Cardiac Surgery, Regional Specialist Hospital, Grudzi¹dz, Poland.
² Department of Neurology, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland.
³ CAROL - Cardiothoracic Anatomy Research Operative Lab, Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland.
⁴ Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland.
⁵ Department of Cardiac Surgery and Transplantology, National Medical Institute of the Ministry of Interior and Administration, Warsaw, Poland.
⁶ Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands.
⁷ Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland.

Abstract

Introduction: Over the past decade, left atrial appendage occlusion (LAAO) has emerged as an established alternative to oral anticoagulation for patients diagnosed with atrial fibrillation (AF). The LARIAT device stands as the sole available epicardial system for complete percutaneous left atrial appendage (LAA) closure.

Aim: To present the extended outcomes (spanning over 9 years of observation) in patients with AF who underwent epicardial LAAO. The presented results constitute the longest observation in world literature.

Material and methods: A prospective, single-center study was conducted on 121 patients undergoing LAAO with the LARIAT system. Incidence of thromboembolic events and severe bleeding and mortality rates were documented. The reduction in the risk of thromboembolism and bleeding after LAAO was quantified.

Results: The mean follow-up duration was 74.18 months. The average CHADS₂ score was 1.9 ±1.0, CHA₂DS₂-VAS score was 2.8 ±1.5, and HAS-BLED score was 2.7 ±1.0. The mean annual thromboembolic event rate was 0.7%, resulting in a 75% reduction in estimated thromboembolic risk. The annual occurrence of major bleeding complications was 0.8%, leading to a 67.9% reduction in estimated bleeding risk. The overall annual mortality rate was 1.2%.

Conclusions: Epicardial LAAO employing the LARIAT device yields commendable long-term outcomes by reducing stroke and bleeding risk.

Keywords: LARIAT; atrial fibrillation; left atrial appendage occlusion; stroke.

Copyright: © 2023 Polish Society of Cardiothoracic Surgeons (Polskie Towarzystwo KardioTorakochirurgów) and the editors of the Polish Journal of Cardio-Thoracic Surgery (Kardiochirurgia i Torakochirurgia Polska).