{"title":"Pulmonary Ridge Coverage: A Two-edged Sword in Left Atrial Appendage Closure With LAmbre","authors":"Jiaxu Shen MD , Yanyan Chen MD , Liangguo Wang MD , Shengjie Wu MD , Hao Zhou MD , Zhouqing Huang PhD , Yihe Chen MD , Xiangxiang Shi MD , Xiao Chen MD , Xinlei Wu MD , Jincheng Xing MD , Zixuan Wang MD , Fangyi Xiao MD","doi":"10.1016/j.cjca.2025.02.018","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>The LAmbre occluder, available in 2 versions, allows for selective coverage of the pulmonary ridge (PR) during left atrial appendage closure (LAAC). In this study we evaluated the effects of PR coverage on imaging and clinical outcomes in patients undergoing LAAC.</div></div><div><h3>Methods</h3><div>Imaging data and clinical events were retrospectively analyzed for patients with nonvalvular atrial fibrillation who successfully underwent LAAC using the LAmbre device at the First Affiliated Hospital of Wenzhou Medical University between October 2018 and May 2022. The primary composite endpoint was thromboembolic (TE) events and device-related thrombus (DRT).</div></div><div><h3>Results</h3><div>In total, 259 patients were evaluated using transesophageal echocardiography (TEE) at median intervals of 52 days (short term) and 385 days (long term). Patients were divided into a PR-covered group (n = 109) and a PR-uncovered group (n = 150). PR-uncovered patients showed a trend toward higher DRT incidence (8 of 150 vs 1 of 109, <em>P</em> = 0.056, log-rank test). The primary composite endpoint of TE events and DRT was significantly lower in the PR-covered group (14.0% vs 6.4%, <em>P</em> = 0.046, log-rank test). Any peridevice leak (PDL) was more frequent in the PR-covered group during both short-term (45.9% vs 28.7%, <em>P</em> = 0.004) and long-term (49.5% vs 25.3%, <em>P</em> < 0.001) follow-up, but no differences were observed for significant PDLs (> 3 mm). PR coverage was identified as an independent predictor of any long-term PDL (odds ratio 3.19, 95% confidence interval 1.64-6.18, <em>P</em> < 0.001).</div></div><div><h3>Conclusions</h3><div>PR coverage during LAAC with the LAmbre device was associated with a reduced risk of the primary composite endpoint of TE events and DRT, albeit with an increased incidence of nonsignificant PDL (≤ 3 mm).</div></div>","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":"41 7","pages":"Pages 1227-1237"},"PeriodicalIF":5.3000,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Canadian Journal of Cardiology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0828282X2500128X","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
Abstract
Background
The LAmbre occluder, available in 2 versions, allows for selective coverage of the pulmonary ridge (PR) during left atrial appendage closure (LAAC). In this study we evaluated the effects of PR coverage on imaging and clinical outcomes in patients undergoing LAAC.
Methods
Imaging data and clinical events were retrospectively analyzed for patients with nonvalvular atrial fibrillation who successfully underwent LAAC using the LAmbre device at the First Affiliated Hospital of Wenzhou Medical University between October 2018 and May 2022. The primary composite endpoint was thromboembolic (TE) events and device-related thrombus (DRT).
Results
In total, 259 patients were evaluated using transesophageal echocardiography (TEE) at median intervals of 52 days (short term) and 385 days (long term). Patients were divided into a PR-covered group (n = 109) and a PR-uncovered group (n = 150). PR-uncovered patients showed a trend toward higher DRT incidence (8 of 150 vs 1 of 109, P = 0.056, log-rank test). The primary composite endpoint of TE events and DRT was significantly lower in the PR-covered group (14.0% vs 6.4%, P = 0.046, log-rank test). Any peridevice leak (PDL) was more frequent in the PR-covered group during both short-term (45.9% vs 28.7%, P = 0.004) and long-term (49.5% vs 25.3%, P < 0.001) follow-up, but no differences were observed for significant PDLs (> 3 mm). PR coverage was identified as an independent predictor of any long-term PDL (odds ratio 3.19, 95% confidence interval 1.64-6.18, P < 0.001).
Conclusions
PR coverage during LAAC with the LAmbre device was associated with a reduced risk of the primary composite endpoint of TE events and DRT, albeit with an increased incidence of nonsignificant PDL (≤ 3 mm).
背景：LAmbre封堵器有两种版本，可在左心房附件关闭（LAAC）期间选择性覆盖肺脊（PR）。本研究评估了PR覆盖对LAAC患者影像学和临床结果的影响。方法：回顾性分析2018年10月至2022年5月在温州医科大学第一附属医院使用LAmbre装置成功行LAAC的非瓣膜性心房颤动患者的影像学资料和临床事件。主要的综合终点是血栓栓塞（TE）事件和DRT。结果：共有259例患者采用经食管超声心动图（TEE）进行评估，中位间隔为52天（短期）和385天（长期）。将患者分为pr覆盖组（n=109）和pr未覆盖组（n=150）。pr未覆盖的患者有较高DRT发生率的趋势（8/150 vs 1/109， P=0.056， log-rank检验）。在pr覆盖组中，TE事件和DRT的主要复合终点显著降低（14.0% vs 6.4%， P=0.046， log-rank检验）。pr覆盖组在短期（45.9% vs 28.7%， P=0.004）和长期随访（49.5% vs 25.3%, P3mm）期间，任何装置周围泄漏（PDL）都更频繁。PR覆盖率被确定为长期任何PDL的独立预测因子（优势比3.19,95%置信区间1.64-6.18）。结论：LAmbre装置LAAC期间PR覆盖率与TE事件和DRT主要复合终点的风险降低相关，尽管不显著PDL（≤3mm）的发生率增加。
期刊介绍：
The Canadian Journal of Cardiology (CJC) is the official journal of the Canadian Cardiovascular Society (CCS). The CJC is a vehicle for the international dissemination of new knowledge in cardiology and cardiovascular science, particularly serving as the major venue for Canadian cardiovascular medicine.
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