TY - JOUR JO - EuroIntervention TI - Transseptal puncture versus patent foramen ovale or atrial septal defect access for left atrial appendage closure AB - <p><strong>Aims:</strong> The aim of this study was to compare the periprocedural and late clinical outcomes of left atrial appendage closure (LAAC) with AMPLATZER devices by access through transseptal puncture (TSP) versus a patent foramen ovale (PFO) or an atrial septal defect (ASD).</p> <p><strong>Methods and results:</strong> Between 2009 and 2018, 578 consecutive patients underwent LAAC via TSP or PFO/ASD access in three centres. After a 3:1 propensity score matching, 246 (TSP) versus 91 (PFO/ASD) patients were compared using the primary efficacy endpoint of all-cause stroke, systemic embolism and cardiovascular/unexplained death and the primary safety endpoint of major periprocedural complications and major bleedings at follow-up. Mean age was 75.2&plusmn;8.7 (TSP) vs 74.4&plusmn;10.9 (PFO/ASD) years, CHA<sub>2</sub>DS<sub>2</sub>-VASc score 4.5&plusmn;1.6 vs 4.3&plusmn;1.4 and HAS-BLED score 3.3&plusmn;1.0 vs 3.3&plusmn;0.9. Device success (97.6% vs 97.8%, p=0.90) was similar. After 2.5&plusmn;1.4 vs 2.6&plusmn;1.6 years, clinical efficacy (46/603, 7.6% [TSP] vs 21/233, 9.0% [PFO/ASD], hazard ratio [HR] 1.2; 95% confidence interval [CI]: 0.69-0.85, p=0.54) and safety (24/603, 4.0% vs 11/233, 4.7%; HR 1.4; 95% CI: 0.52-3.6, p=0.49) did not differ.</p> <p><strong>Conclusions:</strong> Use of a PFO/ASD access for LAAC with AMPLATZER devices offers similar periprocedural and late clinical outcomes to TSP. Simultaneous PFO/ASD closure for an additional protective benefit does not increase risk.</p> AU - Kleinecke Caroline AU - Fuerholz Monika AU - Buffle Eric AU - de Marchi Stefano AU - Schnupp Steffen AU - Brachmann Johannes AU - Nietlispach Fabian AU - Fankhauser Mate AU - Streit R. Samuel AU - Windecker Stephan AU - Meier Bernhard AU - Gloekler Steffen VL - 16 IS - 2 Y1 - 12/06/2020 Y1 - 2020 DOI - 10.4244/EIJ-D-19-00442 SP - e173 EP - e180 KW - laa closure KW - pfo closure KW - ischaemic stroke KW - transseptal KW - atrial fibrillation KW - Bleeding Risk PB - Europa Digital & Publishing SE - Interventions for hypertension and stroke UR - https://eurointervention.pcronline.com/article/amplatzer-left-atrial-appendage-closure-access-via-transseptal-puncture-versus-patent-foramen-ovale-or-atrial-septal-defect SN - 1774-024X ER -