Transseptal Puncture Versus Patent Foramen Ovale or Atrial Septal Defect Access for Left Atrial Appendage Closure.

Aims: 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). Methods and results: 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 +/- 8.7 (TSP) vs 74.4 +/- 10.9 (PFO/ASD) years, CHA(2)DS(2)-VASc score 4.5 +/- 1.6 vs 4.3 +/- 1.4 and HAS-BLED score 3.3 +/- 1.0 vs 3.3 +/- 0.9. Device success (97.6% vs 97.8%, p=0.90) was similar. After 2.5-11.4 vs 2.6-11.6 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. Conclusions: 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.