Long-Term Efficacy and Safety of Left Atrial Appendage Closure Procedures

Abstract

The aim of the present single-center, nonrandomized, retrospective study was to assess the safety and longterm efficacy of percutaneous left atrial appendage closure (LAAC) procedures and to compare the different LAAC devices and therapeutic regimes in this respect.Medical data of 136 patients (pts) (mean age, 72.5 ± 7.6 years; score for atrial fibrillation stroke risk estimation [CHA2DS2-VASc], 4.6 ± 1.6; and score for estimation of major bleeding risk for patients on anticoagulant therapy [HAS-BLED], 2.6 ± 0.9) who underwent percutaneous LAAC procedures in Gottsegen National Cardiovascular Center from January 2010 to January 2020 were analyzed.The rates of outpatient cardiac mortality, ischemic brain event, and major bleeding were 3.8, 1, and 1.9/ 100 pt years, respectively. The rate of successful device deployment was 96.4%. There was one case of procedural mortality (0.7%), one case of device dislocation (0.7%), one case of ischemic stroke (0.7%), and one case of myocardial infarction (0.7%). Two cases of pericardial tamponades (1.5%) and four cases of major femoral complications (3%) occurred. Although the implantation success of different occluder types was similar, significant differences were found concerning procedural characteristics. Patients on single antiplatelet therapy (SAPT) in the first 3 months after the LAAC procedure did not suffer from stroke or embolic events.The present study confirmed the safety and effectivity of percutaneous LAAC. Robust relative stroke risk reduction and less pronounced but significant bleeding risk reduction were observed. Device implantation success was high. The perioperative complication rate was relatively low. The results of long-term observations regarding ischemic events confirmed the safety of using a simplified antithrombotic regime after LAAC in pts with high bleeding risk.

Left atrial appendage closure

“…16 Often, the patient will undergo a TEE and a CT scan of the heart before the procedure so that physicians can determine the preliminary sizing of the device. 1,14 Having the dimensions of the device ahead of time is more efficient and could eliminate the need for general anesthesia. With rapidly advancing technology, three-or four-dimensional intracardiac echocardiography (ICE) is starting to be used more frequently instead of TEE, which makes the procedure more efficient.…”

“…heparin is administered during the procedure. 1 Nurses should closely observe for chest tightness/pain, headache, and dyspnea. Neurovascular assessments should also be performed to check for signs of a stroke (facial droop, decreased muscle strength, and loss of sensation).…”

“…6 The risk of stroke in patients with AF is significantly increased; AF increases the risk of stroke fivefold and is responsible for greater than 20% of all strokes. 1 This is predominantly due to clots that form within the LAA. 7 The LAA is located within the pericardium, in the left upper part of the left atrium, lateral to the pulmonary artery.…”

“…Perhaps you've had the opportunity to care for a patient who's undergone this procedure. It's becoming more routine for some patients with nonvalvular atrial fibrillation (AF) 1. The purpose of this article is to help you become familiar with the procedure, postprocedure nursing care, potential complications, monitoring, patient teaching, and follow-up.…”

“…It's estimated that nearly one-third of the US population over 40 years of age may experience AF 6. The risk of stroke in patients with AF is significantly increased; AF increases the risk of stroke fivefold and is responsible for greater than 20% of all strokes 1. This is predominantly due to clots that form within the LAA 7.…”