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Context: Atrial fibrillation (AF) is the most common arrhythmia in adults. For over 90% of non-valvular AF patients, the left atrial appendage is the primary site of thrombus formation. Left atrial appendage occlusion using the FDA-approved Watchman™ device has been shown to have better clinical outcomes with minimal post-procedural complications when compared to warfarin therapy for patients with contraindications to anticoagulation. Traditionally, this procedure requires an endotracheal tube (ETT) to facilitate transesophageal echocardiography (TEE) guidance. However, recently supraglottic airway (SGA) has emerged as a feasible, non-inferior alternative to ETT for procedures requiring TEE. Aims: Compare outcomes between TEE guided Watchman™ procedures performed with a SGA versus ETT. Settings and Design: A single tertiary care academic medical center. Methods and Materials: Retrospective Observational Study comparing SGA and ETT patients. Statistical Analysis Used: 1:4 propensity score matching of SGA and ETT patients. Results: 42 SGA patients were matched with 155 ETT patients. All patients underwent procedure with TEE. SGA patients had shorter operating room time (11 min difference, P = 0.00001) and considerably shorter PACU length of stays (45 min difference, P = 0.024). Statistically significant, but clinically trivial differences were seen in procedure times (P = 0.015) and fluoroscopy times (P = 0.017). Patients in the SGA group received lower fentanyl (P < 0.00001) dosages. No significant differences were observed in postoperative complications, organ-specific morbidity or 30-day mortality. Conclusions: General anesthesia with SGA is likely a safe, feasible alternative to ETT in Watchman™ procedures requiring TEE guidance. Use of SGA was associated with significant reductions in operating room time and PACU length of stay, potentially offering advantages in terms of resource utilization.

ECMO support was more frequent in the no-reperfusion group (100%) compared with the surgical embolectomy or catheter-based treatment (64.9%) and systemic thrombolysis groups (40.4%; p < 0.001). Duration of ECMO support was significantly higher in the no-reperfusion group (p = 0.032). Details on reperfusion strategies adopted during hospital stay are reported in Table 1. Of note, surgical embolectomy and catheter-based treatment were performed as a secondary strategy (after systemic thrombolysis) in 15.1% and 11.3% of patients, respectively; systemic thrombolysis was performed as a secondary strategy (after surgical embolectomy or catheter-based treatment) in 1.7% of patients. In-hospital all-cause mortality, successful weaning from ECMO, and fatal bleeding were not significantly different among the three groups. A significantly higher rate of in-hospital major bleeding was observed in the systemic thrombolysis group (44.4%) compared with the surgical embolectomy or catheter-based treatment (22.9%) and no-reperfusion groups (14.8%; p = 0.013). After adjustment for age, cardiac arrest as ECMO indication, and use of immediate (upfront) ECMO, the first reperfusion strategy was not independently associated with in-hospital all-cause mortality (adjusted odds ratio 0.87, 95% confidence interval 0.29-2.60, p = 0.797 for systemic thrombolysis vs. surgical embolectomy or catheter-based treatment; adjusted odds ratio 0.87, 95% confidence interval 0.25-3.07, p = 0.