{"id":"194dcd38b074","type":"article","url":"https://hartvaat.nl/2024/01/14/residuele-lekkage-na-laa-occlusie-en-uitkomsten-meta-analyse/","title":"Residuele lekkage na LAA-occlusie en uitkomsten: meta-analyse","title_en":"Residual leaks following percutaneous left atrial appendage occlusion and outcomes: a meta-analysis.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehad828","source_url":"https://doi.org/10.1093/eurheartj/ehad828","authors":["Athanasios Samaras","Andreas S Papazoglou","Charalampos Balomenakis","Alexandra Bekiaridou","Dimitrios V Moysidis","Vasiliki Patsiou","Antonios Orfanidis","George Giannakoulas","George Kassimis","Nikolaos Fragakis","Jacqueline Saw","Ulf Landmesser","Mohamad Adnan Alkhouli","Apostolos Tzikas"],"significance":6,"published":"2024-01-14","source_date":"2024-01-14","image":"","kennis":[],"congress":"","summary_en":"This meta-analysis showed that residual leaks after LAA occlusion are associated with higher thromboembolic risk, particularly larger leaks, informing the importance of complete device sealing and post-procedural surveillance.","created":"2026-07-03T10:30:44Z","updated":"2026-07-03T13:29:47Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse toonde dat residuele lekkage na LAA-occlusie geassocieerd is met een hoger risico op trombo-embolische events. Kleine lekkages (<5 mm) zijn prognostisch relevant, wat de follow-up na LAAO moet intensiveren.","abstract_original":"BACKGROUND AND AIMS: Residual leaks are not infrequent after left atrial appendage occlusion. However, there is still uncertainty regarding their prognostic implications. The aim of this study is to evaluate the impact of residual leaks after left atrial appendage occlusion. METHODS: A literature search was conducted until 19 February 2023. Residual leaks comprised peri-device leaks (PDLs) on transoesophageal echocardiography (TEE) or computed tomography (CT), as well as left atrial appendage patency on CT. Random-effects meta-analyses were performed to assess the clinical impact of residual leaks. RESULTS: Overall 48 eligible studies (44 non-randomized/observational and 4 randomized studies) including 61 666 patients with atrial fibrillation who underwent left atrial appendage occlusion were analysed. Peri-device leak by TEE was present in 26.1% of patients. Computed tomography-based left atrial appendage patency and PDL were present in 54.9% and 57.3% of patients, respectively. Transoesophageal echocardiography-based PDL (i.e. any reported PDL regardless of its size) was significantly associated with a higher risk of thromboembolism [pooled odds ratio (pOR) 2.04, 95% confidence interval (CI): 1.52-2.74], all-cause mortality (pOR 1.16, 95% CI: 1.08-1.24), and major bleeding (pOR 1.12, 95% CI: 1.03-1.22), compared with no reported PDL. A positive graded association between PDL size and risk of thromboembolism was noted across TEE cut-offs. For any PDL of >0, >1, >3, and >5 mm, the pORs for thromboembolism were 1.82 (95% CI: 1.35-2.47), 2.13 (95% CI: 1.04-4.35), 4.14 (95% CI: 2.07-8.27), and 4.44 (95% CI: 2.09-9.43), respectively, compared with either no PDL or PDL smaller than each cut-off. Neither left atrial appendage patency, nor PDL by CT was associated with thromboembolism (pOR 1.45 and 1.04, 95% CI: 0.84-2.50 and 0.52-2.07, respectively). CONCLUSIONS: Peri-device leak detected by TEE was associated with adverse events, primarily thromboembolism. Residual leaks detected by CT were more frequent but lacked prognostic significance."}