Abstract 4369857: The Impact of Transesophageal Echocardiography Operators on Left Atrial Exclusion During AtriClip Procedures

Introduction: Intraoperative transesophageal echocardiography (TEE) is essential to guide left atrial appendage (LAA) closure and exclusion. Despite a significant learning curve, TEE can be performed by different specialties. The impact of TEE operator on LAA exclusion outcomes is not well known. Objective: To evaluate the impact of various TEE operators on LAA exclusion. Methods: We conducted a multicenter, retrospective study of patients from 2018 to 2020 who underwent simultaneous LAA exclusion with the AtriClip (Atricure, Mason, OH) during CONVERGENT ablation. Procedural outcomes were compared between intraoperative TEEs performed by Anesthesia and Cardiology at separate centers. Results: We evaluated 86 patients who underwent TEE by Anesthesiology (n=27) or Cardiology (n=59). Patients in both groups were similar in baseline characteristics. Successful deployment of the AtriClip was achieved in 81.5% of the Anesthesia TEE group versus 94.9% of the Cardiology TEE group (p=0.047). The mean size of the AtriClip (35.4±17.8 vs. 41.4±10.7 mm., p=0.056) and residual stump (10.1±3.8 vs. 9.2±5.4 mm., p=0.666) at the end of the procedure were similar in both groups, as was residual stump > 10 mm (14.8% vs. 16.9%, p<0.666) in follow up. Conclusions: Long-term outcomes of AtriClip are comparable when TEE is guided by Anesthesia or Cardiology.