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Multicenter Study
. 2022 May 15;18(1):50-57.
doi: 10.4244/EIJ-D-21-00713.

Left atrial appendage closure for thrombus trapping: the international, multicentre TRAPEUR registry

Frederic A Sebag  1 , Philippe Garot  2 , Roberto Galea  3 , Ole De Backer  4 , Antoine Lepillier  5 , Antoine De Meesteer  6 , David Hildick-Smith  7 , Sebastien Armero  8 , Ghassan Moubarak  9 , Gregory Ducrocq  10 , Romain Eschalier  11 , Adel Aminian  12 , Antoine Sauguet  13 , Nicolas Lellouche  14 , Khalil Mahmoudi  1 , Lorenz Räber  3 , Nicolas Amabile  1
Affiliations
Multicenter Study

Left atrial appendage closure for thrombus trapping: the international, multicentre TRAPEUR registry

Frederic A Sebag et al. EuroIntervention. .

Abstract

Background: Although the presence of a thrombus contraindicates left atrial appendage closure procedure (LAAC), a previous study reported the feasibility of the thrombus trapping procedure (TTP) technique to overcome this limitation.

Aims: This study aimed to analyse the short-term outcomes in a series of patients who underwent LAAC using the TTP (TTP-LAAC).

Methods: This retrospective series included patients who underwent TTP-LAAC between January 2018 and May 2020 in 13 European centres. Device choice, pre-interventional work-up and post-discharge antithrombotic therapy regimens were left to the discretion of the operators. The primary endpoint was the 30-day occurrence of stroke, systemic embolism or cardiovascular death.

Results: During the study period, a total of 1,918 patients underwent LAAC. A thrombus was identified in 71 cases but completely disappeared in 24 patients before procedure. TTP-LAAC was finally performed in 53 cases (3%). Thrombi were identified ahead of the actual day of implantation in 47 patients (87%) and were mostly limited in size (50 cases with extension <50% of the LAA surface). The Amplatzer Amulet and WATCHMAN FLX occluders were implanted in 44 and 9 patients, respectively. A single deployment approach was applied in 70% and a cerebral embolic protection system was used in 9% of the patients. The overall success rate was 100%. Small pericardial effusion without tamponade was observed in 6% of the cases. Patients were discharged with 72% under antiplatelet therapy and 10% under short-term oral anticoagulation. The primary endpoint occurred in one patient.

Conclusions: TTP-LAAC might be used in a minority of LAAC procedures but appears to be feasible and safe in the short-term, in select cases.

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Conflict of interest statement

F.A. Sebag reports consulting fees from Abbott and Biosense Webster. P. Garot is a minor shareholder in the Cardiovascular European Research Center (CERC). O. De Backer reports institutional research grants and consulting fees for Abbott and Boston Scientific. D. Hildick-Smith is a proctor and on the advisory board of Abbott and Boston Scientific. G. Moubarak reports consulting fees for Abbott. G. Ducrocq reports speaker and/or consulting fees for Amgen, Astra Zeneca, Bayer, BMS, Janssen, Sanofi and Terumo. He has also served as a proctor for Boston Scientific. R. Eschalier reports consulting fees from Boston Scientific. A. Aminian reports proctoring and consulting fees for Abbott and Boston Scientific. N. Lellouche reports consulting fees for Abbott and Boston Scientific. L. Räber reports research grants to his institution from Abbott, Boston Scientific, Biotronik, Medis, Heartflow, Sanofi and Regeneron as well as speaker/consultation fees for Abbott, Amgen, AstraZeneca, Canon, Occlutech, Sanofi and Vifor. N. Amabile reports proctoring for Abbott and Boston Scientific, reports consulting/lecturing fees from Abbott, Boston Scientific and Shockwave and reports research grants to his institution from Abbott. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1. An example of the thrombus trapping procedure.
The thrombus (white arrow) was identified within the LAA in a distal position on CT scan at early (A1-A2) and late phase (A3), and was confirmed by periprocedural TEE (B, C1, C2). LAAC was performed using the “single shot” approach with no LAA catheterisation before deployment. The immediate TEE (D) and eight-week results by CT scan (E) were satisfactory. CT: computed tomography; LAA: left atrial appendage; LAAC: left atrial appendage closure; TEE: transoesophageal echocardiography
Figure 2
Figure 2. Flow chart of the study population.
LAA: left atrial appendage; LAAC: left atrial appendage closure
Figure 3
Figure 3. Evolution of antithrombotic therapy during the TTP-LAAC patients’ management (n=53).
PT: antiplatelet therapy; DOAC: direct oral anticoagulant; LMWH: low molecular weight heparin; UFH: unfractionated heparin; VKA: vitamin K antagonists
Figure 4
Figure 4. Proposed management algorithm for patients with planned LAAC and thrombus identification.
* Hypothesis generated, without strong evidence supporting it. CT: computed tomography; DAPT: double antiplatelet therapy; DRT: device related thrombus; LAA: left atrial appendage; LAAC: left atrial appendage closure; LMWH: low molecular weight heparin; OAC: oral anticoagulation; TEE: transoesophageal echocardiography; TTP: thrombus trapping procedure; UFH: unfractionated heparin
Central illustration
Central illustration. Key baseline and procedural characteristics and main results in the TRAPEUR registry.
LAA: left atrial appendage; LAAC: left atrial appendage closure
See this image and copyright information in PMC

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