Wojciech Wańha, Łukasz Kuźma, Mariusz Kowalewski, Sylwia Iwanczyk, Joanna Grygier, J Jeske, Marco Frazzetto, Radosław Litwinowicz, Marian Burysz, Ewa Gaszewska-Żurek, Claudio Sanfilippo, Tomasz Bochenek, Michał Lelek, Krystian Wita, Zenon Huczek, A Kaplon-Cieslicka, Tomasz Mazurek, P Scislo, Jerzy Sacha, Krzysztof Struniawski, Brunon Tomasiewicz, Facehauwe Mezque, Wiktor Kuliczkowski, Krzysztof Bartuś, Sławomir Dobrzycki, Michał Święczkowski, Anna Kurasz, Paweł Kralisz, Dawid Miśkowiec, J D Kasprzak, Marta Chamera, Maksymilian Mielczarek, Piotr Drewla, Rafał Gałąska, Fabrizio Ugo, Marco Franzino, Bernardo Cortese, Filippo L. GURGOGLIONE, Luigi Vignali, Giorgio Benatti, Federico Barocelli, Piotr Waciński, Piotr Niezgoda, Adam Sukiennik, Jacek Kubica, Mario Iannacone, Klaudia Kowalska, Łukasz Lewicki, Carmelo Grasso, Davide Capodanno, F D A D'ascenzo, Ovidio de Filippo, F Bruno, Radosław Gocoł, Zbigniew Kalarus, Piotr Suwalski, Marek Grygier, Grzegorz Smołka, Gregory Y.H. Lip, Wojciech Wojakowski
BACKGROUND: The balance between thromboembolic complications and bleeding risk in anticoagulated patients with atrial fibrillation remains challenging, with left atrial appendage occlusion (LAAO) representing a potential alternative. Our prospective multicenter study aimed to evaluate the feasibility, safety, technical, and procedural outcomes of the contemporary practice of stand-alone LAAO. METHODS: The SALAMANDER (Stand-Alone Left Atrial Appendage Occlusion for Thromboembolism Prevention in Nonvalvular Atrial Fibrillation Disease) registry is a real-world, multicenter, observational cohort study conducted at 16 cardiac centers in Europe between 2010 and 2024, evaluating the safety and efficacy of LAAO using contemporary devices. RESULTS: -VASc score was 4 (interquartile range, 3-5). The most common indication for LAAO was significant bleeding (83.7% of patients), most frequently during treatment with direct oral anticoagulants (68.8%) more than vitamin K antagonists (24.9%). The predominant bleeding sites were the lower (27.9%) and upper (21.7%) gastrointestinal tracts, with 17.4% having a history of hemorrhagic stroke. The most common antithrombotic regimen before the procedure was direct oral anticoagulants (48.9%), while postprocedural therapy most often included dual antiplatelet therapy (50%). The technical success rate was 95.5%, with residual leak (2.2%) and tamponade (1.4%) as the main causes of failure. Procedural success was 90.5%, most often limited by vascular complications (3.7%), periprocedural death (1.1%), and major bleeding (0.7%). Technical and procedural success rates did not differ significantly between the devices used. CONCLUSIONS: In this large prospective cohort, technical and procedural success rates were similar across all LAAO devices, suggesting comparable safety and efficacy. Postprocedural therapy typically involves dual antiplatelet therapy, with all patients requiring some pharmacological treatment. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT05144958.