الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
This thesis aimed to evaluate safety and efficacy as well as long term outcomes after percutaneous LAAC in patients with heart failure, endpoints and adverse events were categorized according to the Munich consensus document on LAAC.(18) The study analyzed data of 300 patients underwent LAAC in in the period from January 2014 to December 2019 at the University Heart Center Lübeck, Lübeck, Germany, with available follow-up data. where patients included in this study were divided into two groups; a group of patients with no evidence of HF, while the other group included patients with HF and previous history or evidence of decompensation. Median follow-up for the non-HF group was 259 days and 233 days for HF group. The HF group included patients with a reduced LV ejection fraction (LVEF ≤ 40%), patients with a mildly reduced LVEF (LVEF 41–49%), patients with diastolic dysfunction and preserved LVEF (LVEF ≥ 50%), and patients with right-sided heart failure and impaired right ventricular function (tricuspid annular plane systolic excursion < 17 mm). The results of this study proved the safety of percutaneous LAAC in patients with HF as the periprocedural complications including in-hospital death, pericardial tamponade, device embolization, stroke, major bleeding, and vascular access complications showed no significant difference between the studied groups. While long term follow up of in 277 patients, this study showed that patients with HF who were treated with an LAAC had more statistically significant MACCE and more deaths during long-term follow-up compared to patients with non-HF. To date, our study is the first study evaluating a long-term follow-up in high-risk patients with HF and non-valvular AF undergoing LAAC. Implantation of LAAC devices in patients with non-valvular AF and HF is safe without increase of peri-interventional complications in comparison to the non-HF group. In long term follow up of both groups, LAAC shows comparable efficacy in protection against cerebrovascular events while the increased mortality in patients with HF is mainly attributed to comorbidities associated with HF. Usage of LAAC as an alternative method for prevention of cerebrovascular events in patients with contraindications of OAC. Usage of LAAC with standardized protocols seemed to have low rates of peri-procedural complications. Experienced operators should perform LAAC as it poses some technical difficulties needs special training. Further prospective studies to define optimal pharmacological post-LAAC therapy. Further prospective studies with large patient number should be conducted in order to give more evidence about safety and efficacy of the procedure in heart failure patients.