Editorial: Left atrial appendage closure experience; getting to the heart of the matter
“One thorn of experience is worth a whole wilderness of warning.”
– James Russell Lowell
Left atrial appendage closure (LAAO) is a safe and effective procedure for decreasing stroke risk in patients at high risk of stroke who cannot safely take long term anticoagulation [
[1],
[2],
[3],
[4],
[5]]. The overall complication rate is low and success is high, but serious and life-threatening complications can occur [
3,
5,
6]. The best outcomes are seen with a skilled operator and a skilled experienced team. Special expertise in transesophageal echocardiography (TEE) or intracardiac echocardiography (ICE) is also required.
Sawant et al. discuss operator experience and outcomes after transcatheter left atrial appendage closure with the Watchman
Tm (Boston Scientific, St. Paul, MN, USA) device [
7]. In this single center study, they performed 425 Watchman LAOO cases between August 2015 and November 2018 using the original Watchman device. They then compared procedural success and complications based on operator volume and whether operators were electrophysiologists (EP's-41 %) or interventional cardiologist (IC's-59 %).
They studied three groups: Group I: <40 procedures/year, Group 2: 41 to 80 procedures/year and Group 3: >80 procedures per year. Groups 2 and 3 had better device compression but the overall success and complication rates were similar.
Multiple trials have demonstrated success and complications with LA appendage closure. In early trials before 2018 (Protect AF, CAP, Prevail, and Ewolution) major complications varied from 2.7 to 8 %. In the Protect AF trial [
5] pericardial effusions occurred in 4.8 % and major bleeding in 3.5 % of patients.