Heart Team for Left Atrial Appendage Occlusion: A Patient-Tailored Approach.
contraindication oral anticoagulants
heart team
left atrial appendage occlusion
percutaneous procedure
thoracoscopic surgery
Journal
Journal of clinical medicine
ISSN: 2077-0383
Titre abrégé: J Clin Med
Pays: Switzerland
ID NLM: 101606588
Informations de publication
Date de publication:
29 Dec 2021
29 Dec 2021
Historique:
received:
14
11
2021
revised:
23
12
2021
accepted:
27
12
2021
entrez:
11
1
2022
pubmed:
12
1
2022
medline:
12
1
2022
Statut:
epublish
Résumé
Left atrial appendage occlusion (LAAO) is an accepted therapeutic option for stroke prevention; however, the ideal technique and device have not yet been identified. In this study we evaluate the potential role of a heart team approach for patients contraindicated for oral anticoagulants and indicated for left atrial appendage closure, to minimize risk and optimize benefit in a patient-centered decision-making process. Forty patients were evaluated by the heart team for appendage occlusion. Variables considered were CHA Mean duration of procedures and hospital stay were comparable. All patients had complete exclusion of the appendage; at a mean follow up of 33.1 ± 14.1 months, no neurological or hemorrhagic events were reported. A heart team approach may improve the decision-making process for stroke and hemorrhage prevention, where LAAO is a therapeutic option. Percutaneous and thoracoscopic appendage occlusion seem to be comparably safe and effective. An epicardial LAAO could be advisable in patients for whom the risk of bleeding is estimated as being too high for post-procedural antiplatelet therapy.
Sections du résumé
BACKGROUND AND PURPOSE
OBJECTIVE
Left atrial appendage occlusion (LAAO) is an accepted therapeutic option for stroke prevention; however, the ideal technique and device have not yet been identified. In this study we evaluate the potential role of a heart team approach for patients contraindicated for oral anticoagulants and indicated for left atrial appendage closure, to minimize risk and optimize benefit in a patient-centered decision-making process.
METHODS
METHODS
Forty patients were evaluated by the heart team for appendage occlusion. Variables considered were CHA
RESULTS
RESULTS
Mean duration of procedures and hospital stay were comparable. All patients had complete exclusion of the appendage; at a mean follow up of 33.1 ± 14.1 months, no neurological or hemorrhagic events were reported.
CONCLUSIONS
CONCLUSIONS
A heart team approach may improve the decision-making process for stroke and hemorrhage prevention, where LAAO is a therapeutic option. Percutaneous and thoracoscopic appendage occlusion seem to be comparably safe and effective. An epicardial LAAO could be advisable in patients for whom the risk of bleeding is estimated as being too high for post-procedural antiplatelet therapy.
Identifiants
pubmed: 35011916
pii: jcm11010176
doi: 10.3390/jcm11010176
pmc: PMC8745334
pii:
doi:
Types de publication
Journal Article
Langues
eng
Références
JACC Cardiovasc Interv. 2014 Nov;7(11):1205-20
pubmed: 25459035
J Am Coll Cardiol. 2017 Dec 19;70(24):2964-2975
pubmed: 29103847
JACC Cardiovasc Imaging. 2015 Apr;8(4):472-488
pubmed: 25882576
J Am Soc Echocardiogr. 2018 Apr;31(4):454-474
pubmed: 29158017
Am Heart J. 2017 Dec;194:132-140
pubmed: 29223431
J Thorac Cardiovasc Surg. 1999 Nov;118(5):833-40
pubmed: 10534688
Eur Heart J. 2021 Feb 1;42(5):373-498
pubmed: 32860505
Am Heart J. 2020 Aug;226:85-93
pubmed: 32526533
Stroke. 2017 Jun;48(6):1594-1600
pubmed: 28416626
J Am Coll Cardiol. 2017 Feb 21;69(7):777-785
pubmed: 28209218
J Am Coll Cardiol. 2020 Jun 30;75(25):3122-3135
pubmed: 32586585
Eur Heart J Cardiovasc Pharmacother. 2021 Aug 23;:
pubmed: 34423350
Ann Thorac Surg. 2021 Jan;111(1):e61-e63
pubmed: 32569667
Europace. 2015 Dec;17(12):1880-1
pubmed: 25681357
N Engl J Med. 2018 Oct 18;379(16):1499-1508
pubmed: 30221596
Heart Rhythm. 2021 Feb;18(2):313-317
pubmed: 33031962
J Am Coll Cardiol. 2013 Jul 9;62(2):103-107
pubmed: 23433566
Heart Rhythm. 2018 Sep;15(9):1314-1320
pubmed: 29803851
J Cardiovasc Electrophysiol. 2020 Aug;31(8):2187-2191
pubmed: 32495408
Circulation. 2013 Feb 12;127(6):720-9
pubmed: 23325525
J Thorac Cardiovasc Surg. 2016 Oct;152(4):1075-80
pubmed: 27422360
Eur J Cardiothorac Surg. 2015 May;47(5):847-54
pubmed: 25064051
J Am Coll Cardiol. 2012 Aug 7;60(6):531-8
pubmed: 22858289
Am J Med. 2011 Feb;124(2):111-4
pubmed: 20887966
Eur Heart J. 2016 Aug;37(31):2465-74
pubmed: 26822918
Ann Thorac Surg. 1996 Feb;61(2):755-9
pubmed: 8572814
Lancet. 2009 Aug 15;374(9689):534-42
pubmed: 19683639
Stroke. 2001 Oct;32(10):2232-6
pubmed: 11588306
N Engl J Med. 2009 May 14;360(20):2066-78
pubmed: 19336502
JACC Clin Electrophysiol. 2018 Jul;4(7):893-901
pubmed: 30025689
Circ Arrhythm Electrophysiol. 2019 Apr;12(4):e006841
pubmed: 30939908
Eur J Cardiothorac Surg. 2014 Jan;45(1):126-31
pubmed: 23657550
J Am Coll Cardiol. 2008 Sep 9;52(11):924-9
pubmed: 18772063
N Engl J Med. 2009 Sep 17;361(12):1139-51
pubmed: 19717844
Lancet. 2014 Mar 15;383(9921):955-62
pubmed: 24315724