ABSTRACT
Background: Left atrial appendage closure (LAAC) devices are a practical replacement to long term oral anticoagulation in the appropriate patient. Incomplete occlusion and resulting device leak are important clinical endpoints which may prompt anticoagulation continuation. During the coronavirus pandemic, cardiac computed tomography (CCT) was used as an alternative to transesophageal echocardiogram (TEE) for pre-planning and post-operative confirmation. A residual leak of >5mm on TEE has been used as a cutoff for anticoagulation continuation, but CCT is less codified for device leak quantification and its significance. Objective: Compare CCT and TEE in regards to post-operative leak with respect to resulting outcomes after LAAC device implant. Methods: Between March 1st 2020 and October 31st 2021, 151 patients underwent LAAC device implantation at a single center. These patients had a pre-procedural CCT or TEE and a subsequent confirmatory CCT or TEE 45 days after implant. Baseline demographics, imaging, device characteristics, and resulting outcome measures were collected by chart review. Data was then retrospectively analyzed with a non-linear model to assess significance. Results: Of the 151 patients, the median age was 77 with an interquartile range (IQR) of 10 and 40% were female. The median CHADSVASc was 4 and HASBLED score was 4 with an IQR of 2 and 1, respectively. For the 45 day post-procedural imaging confirmation there was a total of 110 patients who underwent TEE, 30 underwent CCT, and 11 dropped out. A total of 34 patients (22%) had a device leak of any size. In CCT group there were 18 patients (60%) with a device leak <5mm and in the TEE group 16 patients (15%) had a device leak with 14 having a primary leak <5mm (P < 0.001). Major adverse events include: 1 death (all-cause), 14 major bleeding events, 1 MACE event (MI). There was zero instances of post-device stroke. None of these outcomes were statistically significant in regards to device leak or imaging modality. Conclusion: Based on this analysis, CCT had a significantly greater rate of detecting post-operative device leak when compared to TEE. There does not appear to be any significant difference in outcomes with regards to CCT and TEE in patients undergoing LAAC device implant. This suggests that CCT may be overly sensitive for subclinical device leak.