Percutaneous left atrial appendage occlusion in a frail, high-risk, octogenarian patient population, after having undergone transcatheter aortic valve implantation.
Atrial fibrillation
Bleeding risk
Elderly
Frail
Left atrial appendage occlusion
Journal
BMC cardiovascular disorders
ISSN: 1471-2261
Titre abrégé: BMC Cardiovasc Disord
Pays: England
ID NLM: 100968539
Informations de publication
Date de publication:
02 08 2022
02 08 2022
Historique:
received:
13
03
2022
accepted:
22
07
2022
entrez:
2
8
2022
pubmed:
3
8
2022
medline:
5
8
2022
Statut:
epublish
Résumé
Percutaneous left atrial appendage occlusion (LAAO) represents an alternative stroke prevention method in patients with atrial fibrillation and an increased bleeding risk, chronic kidney disease or contraindications to oral anticoagulants. Aim of our study was to evaluate the feasibility and safety of percutaneous LAAO in high-risk, frail patients having undergone transcatheter aortic valve implantation (TAVI). Thirty-one patients having undergone TAVI and scheduled for LAAO were prospectively included in our study. Implantation was successful in 29 of 31 cases (93.5%).There were no patients that developed a major acute cardiovascular event, stroke, or device dislocation/embolization. There was a single case of major bleeding (3.2%) and 3 cases of acute kidney injury (9.7%). At 3 months, no patients experienced a stroke, one patient had a device-related thrombus (3.4%), one patient showed a significant peri-device leak, and one patient had a persistent iatrogenic atrial septal defect. Our study shows that percutaneous LAAO may represent a feasible alternative strategy for stroke prevention, that can be safely performed in high-risk, multimorbid patients with high bleeding risk or contraindications to oral anticoagulation.
Sections du résumé
BACKGROUND
Percutaneous left atrial appendage occlusion (LAAO) represents an alternative stroke prevention method in patients with atrial fibrillation and an increased bleeding risk, chronic kidney disease or contraindications to oral anticoagulants. Aim of our study was to evaluate the feasibility and safety of percutaneous LAAO in high-risk, frail patients having undergone transcatheter aortic valve implantation (TAVI).
METHODS
Thirty-one patients having undergone TAVI and scheduled for LAAO were prospectively included in our study.
RESULTS
Implantation was successful in 29 of 31 cases (93.5%).There were no patients that developed a major acute cardiovascular event, stroke, or device dislocation/embolization. There was a single case of major bleeding (3.2%) and 3 cases of acute kidney injury (9.7%). At 3 months, no patients experienced a stroke, one patient had a device-related thrombus (3.4%), one patient showed a significant peri-device leak, and one patient had a persistent iatrogenic atrial septal defect.
CONCLUSIONS
Our study shows that percutaneous LAAO may represent a feasible alternative strategy for stroke prevention, that can be safely performed in high-risk, multimorbid patients with high bleeding risk or contraindications to oral anticoagulation.
Identifiants
pubmed: 35918658
doi: 10.1186/s12872-022-02786-4
pii: 10.1186/s12872-022-02786-4
pmc: PMC9344699
doi:
Substances chimiques
Anticoagulants
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
349Informations de copyright
© 2022. The Author(s).
Références
JACC Cardiovasc Interv. 2017 Feb 27;10(4):391-399
pubmed: 28231907
J Am Coll Cardiol. 2021 Jun 1;77(21):2717-2746
pubmed: 33888385
Catheter Cardiovasc Interv. 2015 Nov;86(5):E224-8
pubmed: 26010062
JACC Cardiovasc Interv. 2016 Jul 25;9(14):1487-95
pubmed: 27478117
JACC Cardiovasc Interv. 2016 May 9;9(9):937-46
pubmed: 27085579
Eur Heart J. 2021 Feb 1;42(5):373-498
pubmed: 32860505
J Am Coll Cardiol. 2020 Apr 7;75(13):1503-1518
pubmed: 32238316
Arch Cardiovasc Dis. 2014 Jun-Jul;107(6-7):353-60
pubmed: 24996564
EuroIntervention. 2020 Jan 17;15(13):1133-1180
pubmed: 31474583
Minerva Med. 2020 Jun;111(3):203-212
pubmed: 32525293
J Am Coll Cardiol. 2017 Dec 19;70(24):2964-2975
pubmed: 29103847
Eur Heart J. 2016 Jul 21;37(28):2217-25
pubmed: 26819226
Eur J Cardiothorac Surg. 1999 Jun;15(6):816-22; discussion 822-3
pubmed: 10431864
Circulation. 2019 Mar 5;139(10):e56-e528
pubmed: 30700139
Lancet. 2009 Aug 15;374(9689):534-42
pubmed: 19683639
J Am Coll Cardiol. 2020 Jun 30;75(25):3122-3135
pubmed: 32586585
PLoS One. 2015 Oct 14;10(10):e0140386
pubmed: 26465747
J Am Coll Cardiol. 2014 Jul 8;64(1):1-12
pubmed: 24998121
Eur Heart J. 2022 Feb 12;43(7):561-632
pubmed: 34453165