Incidence, Characteristics and Management of Persistent Peri-Device Flow After Percutaneous Left Atrial Appendage Occlusion

<b>Background</b>: Severe peri-device leaks after left atrial appendage (LAA) occlusion require continuation of life-long oral anticoagulation. However, majority of patients referred for LAA occlusion are not suitable for anticoagulation. Data on the incidence, characteristics and management of peri-device leak after LAA occlusion are scarce. <b>Methods</b>: We assessed the incidence of peri-device leak, its characteristics, and their management outcomes 200 consecutive patients who underwent LAA occlusion between April 2016 and August 2018. <b>Results</b>: Severe persistent peri-device flow was present in 9/200 patients (4.5%) at 45 days. Baseline clinical characteristics were comparable between patients with or without severe leaks. However, patients with severe leaks had larger LAA diameter (24.5±4.3 vs. 19.8±3.7 mm, p&lt;0.001), and more sub-optimal deployments (100% vs. 26.7%, p&lt;0.001). Sub-optimal deployment parameters included: non-coaxial deployment, preferential single lobe deployment, incomplete coverage of a proximal side lobe, and shallow implantation. Among patients with severe leaks, 2 (22%) remained on oral anticoagulation and 7 (78%) underwent percutaneous closure. Percutaneous closure with the Amplatzer Vascular Plug-II device had a 100% success rate and no short-term complications. <b>Conclusions</b>: Severe peri-device leak is present in ~5% of patients following LAA occlusion. Certain anatomical and procedural factors might contribute to the occurrence of peri-device leak. Severe leaks can be effectively closed with percutaneous techniques.

**背景**：左心耳（left atrial appendage, LAA）封堵术后发生的严重器械周围漏（peri-device leak），需患者终身接受口服抗凝治疗。然而，多数拟行左心耳封堵术的患者并不适合抗凝治疗。目前关于左心耳封堵术后器械周围漏的发生率、临床特征及管理方案的相关研究数据仍较为匮乏。
**方法**：本研究纳入2016年4月至2018年8月期间接受左心耳封堵术的200例连续入组患者，评估了术后器械周围漏的发生率、特征及其管理结局。
**结果**：术后45天，共9例（4.5%）患者存在严重持续性器械周围血流渗漏。有无严重渗漏的患者基线临床特征无显著差异。但严重渗漏患者的左心耳直径更大（24.5±4.3 mm vs. 19.8±3.7 mm，p<0.001），且器械放置欠佳比例更高（100% vs. 26.7%，p<0.001）。器械放置欠佳的参数包括：同轴性不佳、优先单叶放置、近端侧叶覆盖不全及植入深度过浅。在出现严重渗漏的患者中，2例（22%）继续接受口服抗凝治疗，7例（78%）接受了经皮封堵治疗。采用Amplatzer血管塞-II（Amplatzer Vascular Plug-II）装置行经皮封堵的成功率达100%，且未出现短期并发症。
**结论**：左心耳封堵术后约5%的患者会出现严重器械周围漏。特定的解剖学因素与操作因素可能与器械周围漏的发生相关。严重渗漏可通过经皮技术实现有效封堵。