{"id":"00aca3311f30","type":"article","url":"https://hartvaat.nl/2026/05/19/salamander-register-95-5-technisch-succes-bij-stand-alone-linker-hartoor-occlusi/","title":"SALAMANDER-register: 95,5% technisch succes bij stand-alone linker-hartoor-occlusie in Europese praktijk","title_en":"","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"Journal of the American Heart Association","doi":"10.1161/JAHA.125.046625","source_url":"https://doi.org/10.1161/JAHA.125.046625","authors":["Wojciech Wańha","Łukasz Kuźma","Mariusz Kowalewski","Sylwia Iwańczyk","Joanna Grygier","Jan Jeske","Marco Frazzetto","Radosław Litwinowicz","Marian Burysz","Ewa Gaszewska-Żurek","Claudio Sanfilippo","Tomasz Bochenek","Michał Lelek","Krystian Wita","Zenon Huczek","Agnieszka Kapłon-Cieślicka","Tomasz Mazurek","Piotr Scisło","Jerzy Sacha","Krzysztof Struniawski","Brunon Tomasiewicz","Facehauwe Mezque","Wiktor Kuliczkowski","Krzysztof Bartuś","Sławomir Dobrzycki","Michał Święczkowski","Anna Kurasz","Paweł Kralisz","Dawid Miśkowiec","Jarosław D Kasprzak","Marta Chamera","Maksymilian Mielczarek","Piotr Drewla","Rafał Gałąska","Fabrizio Ugo","Marco Franzino","Bernardo Cortese","Filippo L Gurgoglione","Luigi Vignali","Giorgio Benatti","Federico Barocelli","Piotr Waciński","Piotr Niezgoda","Adam Sukiennik","Jacek Kubica","Mario Iannacone","Klaudia Kowalska","Łukasz Lewicki","Carmelo Grasso","Davide Capodanno","Fabrizio D'Ascenzo","Ovidio de Filippo","Francesco Bruno","Radosław Gocoł","Zbigniew Kalarus","Piotr Suwalski","Marek Grygier","Grzegorz Smolka","Gregory Y H Lip","Wojciech Wojakowski"],"significance":7,"published":"2026-06-10","source_date":"2026-05-19","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/","https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"Prospective multicenter observational cohort of 1,660 patients with non-valvular atrial fibrillation undergoing stand-alone left atrial appendage occlusion (LAAO) at 16 European centres between 2010 and 2024. Median age 76 years (IQR 70-81); 38% women; median CHA2DS2-VASc 4. Indication was significant bleeding in 83.7% — most often on DOAC (68.8%) and less often VKAs (24.9%); main bleeding sites were lower (27.9%) and upper (21.7%) GI tract, with 17.4% history of haemorrhagic stroke. Technical success 95.5% (limited mainly by residual leak 2.2% and tamponade 1.4%); procedural success 90.5% (vascular complications 3.7%, periprocedural death 1.1%). Results were comparable across devices. Virtually all patients received dual antiplatelet therapy post-procedure.","created":"2026-07-03T10:33:01Z","updated":"2026-07-03T13:31:56Z","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":"Prospectief multicenter observationeel cohort bij 1.660 patiënten met non-valvulair atriumfibrilleren die tussen 2010 en 2024 in 16 Europese centra een stand-alone linker-hartoor-occlusie (LAAO) ondergingen. Mediane leeftijd 76 jaar (IQR 70-81); 38% vrouw; mediane CHA2DS2-VASc 4. De indicatie was bij 83,7% een significante bloeding — meestal tijdens DOAC-therapie (68,8%) en minder vaak tijdens VKA's (24,9%); voornaamste bloedingsplekken waren onderste (27,9%) en bovenste (21,7%) maagdarmkanaal, met 17,4% voorgeschiedenis van hemorragisch CVA. Technisch succes 95,5% (vooral begrensd door restlekkage 2,2% en tamponade 1,4%); procedureel succes 90,5% (vasculaire complicaties 3,7%, periprocedurele sterfte 1,1%). Resultaten waren vergelijkbaar over verschillende devices. Vrijwel alle patiënten kregen na de procedure dubbele plaatjesremming.","abstract_original":"BACKGROUND: The balance between thromboembolic complications and bleeding risk in anticoagulated patients with atrial fibrillation remains challenging, with left atrial appendage occlusion (LAAO) representing a potential alternative. Our prospective multicenter study aimed to evaluate the feasibility, safety, technical, and procedural outcomes of the contemporary practice of stand-alone LAAO. METHODS: The SALAMANDER (Stand-Alone Left Atrial Appendage Occlusion for Thromboembolism Prevention in Nonvalvular Atrial Fibrillation Disease) registry is a real-world, multicenter, observational cohort study conducted at 16 cardiac centers in Europe between 2010 and 2024, evaluating the safety and efficacy of LAAO using contemporary devices. RESULTS: A total of 1660 patients were enrolled, with a median age of 76 (interquartile range, 70-81) years and 38% being women. The median CHA2DS2-VASc score was 4 (interquartile range, 3-5). The most common indication for LAAO was significant bleeding (83.7% of patients), most frequently during treatment with direct oral anticoagulants (68.8%) more than vitamin K antagonists (24.9%). The predominant bleeding sites were the lower (27.9%) and upper (21.7%) gastrointestinal tracts, with 17.4% having a history of hemorrhagic stroke. The most common antithrombotic regimen before the procedure was direct oral anticoagulants (48.9%), while postprocedural therapy most often included dual antiplatelet therapy (50%). The technical success rate was 95.5%, with residual leak (2.2%) and tamponade (1.4%) as the main causes of failure. Procedural success was 90.5%, most often limited by vascular complications (3.7%), periprocedural death (1.1%), and major bleeding (0.7%). Technical and procedural success rates did not differ significantly between the devices used. CONCLUSIONS: In this large prospective cohort, technical and procedural success rates were similar across all LAAO devices, suggesting comparable safety and efficacy. Postprocedural therapy typically involves dual antiplatelet therapy, with all patients requiring some pharmacological treatment. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT05144958."}