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Echocardiographic assessment of peridevice leaks and thrombu after left atrial appendage closure.
Catalonia (AECS) - University Pompeu Fabra (UPF) - Campus Universitari Mar, Barcelona
Cardiology Department, Hospital del Mar, Passeig Maritim 25/29, 08003, Barcelona, Spain
Dr. Aleksandra Mas-Stachurska
Dr. Aleksandra Mas-Stachurska
English, Catalan, Spanish or Polish
Type of Research Project
- Clinical Project without Laboratory work
What is the background of the project?
Left atrial appendage (LAA) closure for stroke prevention in the setting of non-valvular atrial fibrillation is an alternative to oral anticoagulation in patients with increased bleeding risk. It allows similar reduction in thromboembolic events, in particular stroke, compared to warfarin. A common clinical dilemma is the management of patients with peri-device leak and thrombus after LAA occlusion. This has been documented in both percutaneous as well as surgical approaches. The specific definitions of leak and thrombus severity, and the longer-term clinical implications are poorly understood. It is fundamental to know the mechanisms of incomplete occlusion and thrombosis, the data regarding thromboembolic risk in patients with incomplete appendage closure, so that provide recommendations for management in these patients.
What is the aim of the project?
The objective of our study is to provide the ultrasound assessment of the LAA closure peridevice leak and trombus and determine the predisposing factors in their formation likewise the relationship with possible stroke.
What techniques and methods are used?
1) Transesophageal echocardiographic (TEE) analysis of the left appendage morphology before the LAA closure 2) Measurements of the ostium, neck and depth of the LAA. 3) Assessment of the morphology of the LAA: cactus, wind sock, chicken wing and cauliflower. 4) TEE analysis of the sizing parameters of the implanted LAA closure device (umbrella size, cover disc size). 4) TEE detection of the possible leak and thrombus before, during and after the percutaneous procedure. 5) Sizing of the leak flow and direction in Colour Doppler. 5) Analysis of relation between the morphology of LAA, device size and possible complication. 5) Analysis between the complication (leak and thrombus) and the stroke in the follow up. Expected results are that the large leak may correlate with thrombus formation in the follow up and the large device may correlate with leak occurrence. We pretend to elucidate if the large size of de3vice may correlate with the thrombus and stroke in the follow up. Statistical analysis: Continuous variables will be expressed as mean ± standard deviation (SD). Assessment of normal distribution will be performed using the Kolmogorov-Smirnov test or Shapiro-Wilk test, depending on the size of the group assessed. Categorical variables will be expressed as percentages and absolute values. To assess the presence of any difference between device with leak and device without the leak, the two-sample t-test (adjusting for unequal variances) will be used to compare continuous variables if normally distributed and the Mann-Whitney U test was used otherwise. Categorical variables will be compared using the χ2 test. Inter-observer and intra-observer reproducibility of the PST observations will be assessed using Cohen’s Kappa statistics on ten randomly selected. We will consider a statistical significance of 5% for all the tests. The statistical analysis was done using SPSS version 21.0 (SPSS Inc., Chicago, IL, USA)
What is the role of the student?
- The student will observe the practical experiments but will be highly involved in the analysis of the results
- The tasks will be done under supervision
What are the tasks expected to be accomplished by the student?
The student will complete some different tasks: First of all, the student will work on collecting data from the echocardiographic images stored in the work station (measure the depth, width and size of the left atrial appendage, size of the leak and thrombus) Later, the student will introduce some data in the SPSS database (which will be taught how to it works). Then, the student will look for some articles to complete the information of the study, the articles will change depending on the moment that the student will take place in the project. Once the information is collected, the student will help the researcher team to analyse the data and come up with the best hypothesis. The hypothesis expected is that the peridevice leak size may have correlation with thrombus formation in long term follow up and consequently with the stroke occurrence.
Will there be any theoretical teaching provided (preliminary readings, lectures, courses, seminars etc)
Preliminary reading and theoretical formation in the cardiac transesophageal ultrasound anatomy.
What is expected from the student at the end of the research exchange? What will be the general outcome of the student?
- The student will prepare a poster - The student will prepare a scientific report - The student’s name will be mentioned in a future publication - The student will have the opportunity to present the results together with the supervisor at a conference
What skills are required of the student? Is there any special knowledge or a certain level of studies needed?
Heart anatomy. Subjects passed: Anatomy (specially, the one related with the heart).
Are there any legal limitations in the student’s involvement
Type of students accepted
This project accepts: - Medical students - Graduated students (less than 6 months) - Students in biomedical fields
- 1) EuroIntervention. 2017 Nov 20;13(10):1218-1225. Residual leaks following percutaneous left atrial appendage occlusion: assessment and management implications. Raphael CE; Friedman PA; Saw J; Pislaru SV; Munger TM; Holmes DR Jr
- 2) Circ Cardiovasc Interv. 2018 Mar;11(3):e005997. Device Thrombosis After Percutaneous Left Atrial Appendage Occlusion Is Related to Patient and Procedural Characteristics but Not to Duration of Postimplantation Dual Antiplatelet Therapy. Pracon R; Bangalore S; Dzielinska Z; Konka M; Kepka C.
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