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Golzarian H, Pasley BA, Shah SR, Thiel AM, Knous M, Kleman AC, Saum JL, Hempfling GL, Otto M, Otto T, Racer L, Martz D, Gemmel DJ, Laird AD, Cole WC, Parsa P, Imm C, Patel SM. Single-Operator Left atrial appendage Occlusion utilizing Conscious sedation TEE, Lack of Outpatient pre-imaging, and Same-day Expedited discharge (SOLO-CLOSE): A comparison with conventional approach. Catheter Cardiovasc Interv 2024; 104:330-342. [PMID: 38736248 DOI: 10.1002/ccd.31073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 04/24/2024] [Accepted: 04/29/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND Left atrial appendage occlusion (LAAO) with WATCHMAN currently requires preprocedural imaging, general anesthesia, and inpatient overnight admission. We sought to facilitate simplification of LAAO. AIMS We describe and compare SOLO-CLOSE (single-operator LAA occlusion utilizing conscious sedation TEE, lack of outpatient pre-imaging, and same-day expedited discharge) with the conventional approach (CA). METHODS A single-center retrospective analysis of 163 patients undergoing LAAO between January 2017 and April 2022 was conducted. The SOLO-CLOSE protocol was enacted on December 1, 2020. Before this date, we utilized the CA. The primary efficacy endpoint was defined as successful LAAO with ≤5 mm peri-device leak at time of closure. The primary safety endpoint was the composite incidence of all-cause deaths, any cerebrovascular accident (CVA), device embolization, pericardial effusion, or major postprocedure bleeding within 7 days of the index procedure. Procedure times, 7-day readmission rates, and cost analytics were collected as well. RESULTS Baseline characteristics were similar in both cohorts. Congestive heart failure (37.5% vs. 11.1%) and malignancy (28.8% vs. 12.5%) were higher in SOLO-CLOSE. Median CHA2D2SVASc score was 5 in both cohorts. The primary efficacy endpoint was met 100% in both cohorts. Primary safety endpoint was similar between cohorts (p = 0.078). Mean procedure time was 30 min shorter in SOLO-CLOSE (p < 0.01). Seven-day readmissions for SOLO-CLOSE was zero. After SOLO-CLOSE implementation, there was a 188% increase in positive contribution margin per case. CONCLUSIONS The SOLO-CLOSE methodology offers similar efficacy and safety when compared to the CA, while improving clinical efficiency, reducing procedural times, and increasing economic benefit.
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Affiliation(s)
- Hafez Golzarian
- Department of Internal Medicine, Internal Medicine Residency Program, Mercy Health-St. Rita's Medical Center, Lima, Ohio, USA
| | - Benjamin A Pasley
- Department of Internal Medicine, Internal Medicine Residency Program, Mercy Health-St. Rita's Medical Center, Lima, Ohio, USA
| | - Sidra R Shah
- Department of Internal Medicine, Internal Medicine Residency Program, Mercy Health-St. Rita's Medical Center, Lima, Ohio, USA
| | - Arielle M Thiel
- Department of Cardiology, Structural Heart & Intervention Center, Bon Secours Mercy Health-St. Rita's Medical Center, Lima, Ohio, USA
| | - Mallory Knous
- Department of Cardiology, Structural Heart & Intervention Center, Bon Secours Mercy Health-St. Rita's Medical Center, Lima, Ohio, USA
| | - Anna C Kleman
- Department of Cardiology, Structural Heart & Intervention Center, Bon Secours Mercy Health-St. Rita's Medical Center, Lima, Ohio, USA
| | - Jamie L Saum
- Department of Cardiology, Structural Heart & Intervention Center, Bon Secours Mercy Health-St. Rita's Medical Center, Lima, Ohio, USA
| | - Gerri L Hempfling
- Department of Cardiology, Structural Heart & Intervention Center, Bon Secours Mercy Health-St. Rita's Medical Center, Lima, Ohio, USA
| | - Michael Otto
- Department of Cardiothoracic & Vascular Surgery, Bon Secours Mercy Health-St. Rita's Medical Center, Lima, Ohio, USA
| | - Todd Otto
- Department of Cardiothoracic & Vascular Surgery, Bon Secours Mercy Health-St. Rita's Medical Center, Lima, Ohio, USA
| | - Lisa Racer
- Department of Cardiology, Structural Heart & Intervention Center, Bon Secours Mercy Health-St. Rita's Medical Center, Lima, Ohio, USA
| | - Denise Martz
- Department of Cardiology, Structural Heart & Intervention Center, Bon Secours Mercy Health-St. Rita's Medical Center, Lima, Ohio, USA
| | - David J Gemmel
- Department of Internal Medicine, Graduate Medical Education Research, Bon Secours Mercy Health-St. Elizabeth Youngstown Hospital, Youngstown, Ohio, USA
| | - Amanda D Laird
- Department of Critical Care, Bon Secours Mercy Health-St. Rita's Medical Center, Lima, Ohio, USA
| | - William C Cole
- Department of Critical Care, Bon Secours Mercy Health-St. Rita's Medical Center, Lima, Ohio, USA
| | - Prabhakar Parsa
- Department of Anesthesia, Bon Secours Mercy Health-St. Rita's Medical Center, Lima, Ohio, USA
| | - Craig Imm
- Department of Anesthesia, Bon Secours Mercy Health-St. Rita's Medical Center, Lima, Ohio, USA
| | - Sandeep M Patel
- Department of Cardiology, Structural Heart & Intervention Center, Bon Secours Mercy Health-St. Rita's Medical Center, Lima, Ohio, USA
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Cetinkaya A, Zeriouh M, Liakopoulos OJ, Hein S, Siemons T, Bramlage P, Schönburg M, Choi YH, Richter M. Minimally invasive left atrial appendage (LAA) clip insertion after challenging LAA occluder implantation to minimize the risk of stroke. J Surg Case Rep 2020; 2020:rjaa432. [PMID: 33269069 PMCID: PMC7695449 DOI: 10.1093/jscr/rjaa432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/16/2020] [Accepted: 09/21/2020] [Indexed: 11/15/2022] Open
Abstract
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, requiring lifelong anticoagulation or interventional, transseptal left atrial appendage (LAA) occluder implantation to minimize stroke risk. Incomplete LAA closure post implantation is a frequent observation. Incomplete LAA occlusion after transseptal occluder implantation necessitates anticoagulation in cases of persistent AF to minimze risk of embolism and/or apoplexy. Patients with contraindications to lifelong anticoagulation therapy are challenging to treat and alternative options are needed. We present a case of a patient with persistent AF who underwent frustraneous LAA occluder implantation. The patient's anatomy necessitated surgical closure of the LAA, which was accomplished with an LAA clip 4 weeks after implantation. The patient was discharged in excellent clinical status 5 days after the surgery. No further complications were observed within the following year.
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Affiliation(s)
- Ayse Cetinkaya
- Department of Cardiac Surgery, Kerckhoff-Heart Center, Bad Nauheim, Germany
| | - Mohamed Zeriouh
- Department of Cardiac Surgery, Kerckhoff-Heart Center, Bad Nauheim, Germany
| | | | - Stefan Hein
- Department of Cardiac Surgery, Kerckhoff-Heart Center, Bad Nauheim, Germany
| | - Tamo Siemons
- Department of Radiology, Kerckhoff-Heart Center, Bad Nauheim, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Markus Schönburg
- Department of Cardiac Surgery, Kerckhoff-Heart Center, Bad Nauheim, Germany
| | - Yeong-Hoon Choi
- Department of Cardiac Surgery, Kerckhoff-Heart Center, Bad Nauheim, Germany
| | - Manfred Richter
- Department of Cardiac Surgery, Kerckhoff-Heart Center, Bad Nauheim, Germany
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