Same-day discharge for left atrial appendage occlusion procedure: A systematic review and meta-analysis

Contemporary European practice in left atrial appendage closure: results from a survey focusing on planning, techniques and post-implantation management

OBJECTIVES

The purpose of this European survey was to describe current preprocedural planning, procedure techniques and post-implantation management of left atrial appendage closure (LAAC).

DESIGN

Prospective survey regarding current practice for LAAC between March and August 2023.

SETTING

357 participating European LAAC centres in 14 countries.

RESULTS

In 2022, the participating centres performed a total number of 9447 LAAC procedures, with a mean of 26 LAAC cases per centre (median 20; IQR 10-35). Preprocedure planning was performed with transoesophageal echocardiography (TOE) in 63% of centres, cardiac CT in 16%, or both in 21%. LAAC procedures were performed under general anaesthesia (59%), conscious sedation (36%) or with local anaesthesia only (5%). Device implantation was guided by conventional TOE (94%), intracardiac echocardiography (6%), miniaturised TOE probes (4%) or CT/fluoroscopy fusion (2%). The standard post-procedural antithrombotic regimen was dual antiplatelet therapy (73%), followed by single antiplatelet therapy (18%), conventional dose direct oral anticoagulant (DOAC) (7%) or half dose DOAC (1%), and no antithrombotic treatment (1%). There was a large heterogeneity between regions in terms of procedure volumes, hospital organisation, preprocedural planning, as well as procedural techniques and post-procedure management.

CONCLUSIONS

The present survey indicates that LAAC has become a widespread procedure in Europe. The findings highlight considerable heterogeneity among European countries in terms of preprocedural planning, procedural techniques including guidance and the post-procedural antithrombotic regimen. There is a need to evaluate the outcomes of different practices.

Percutaneous left atrial appendage closure using a modified single-operator-technician approach under deep sedation: A single-center experience

Background

Historically, percutaneous transcatheter left atrial appendage closure (LAAC) has been performed under general anesthesia (GA) with transesophageal echocardiographic images obtained by a noninvasive cardiologist and usually requires an overnight hospital stay. Alternatively, we present our single-center experience performing LAACs under deep sedation (DS), employing an echocardiographic technician instead of a noninvasive cardiologist, and expediting same-day discharge. Mid- to long-term outcomes were also evaluated with follow-up imaging at a 45-day visit.

Objective

The purpose of this study was to demonstrate the safety, feasibility, and outcomes of our single-operator-technician LAAC approach.

Methods

A total of 150 patients, with elevated CHA2DS2-VASc scores (a mean of 4 points), underwent transesophageal echocardiography-guided LAAC using the WATCHMAN FLX (Boston Scientific, Marlborough, MA) device under DS.

Results

The mean age of patients was 78 years. Seventy-six (51%) were men. One hundred forty-seven patients (98%) had the LAAC device successfully implanted, and 145 (97%) were discharged on the same day. Nine patients (6%) required conversion from DS to GA. Only 5 patients (4%) had complications during the procedure. None of the patients died or had complications from DS. During the 45-day follow-up visit, one patient had a significant peridevice leak (maximum diameter ≥ 5 mm) and another patient had device-related thrombosis.

Conclusion

Our novel single-operator-technician approach under DS is safe and feasible. Implementing protocols to simplify the traditional 2-operator approach under GA by using DS and an echocardiography technician as well as incorporating same-day discharge could make LAACs more widely available and potentially reduce procedural costs.

Same-Day Discharge After Percutaneous Left Atrial Appendage Occlusion Procedures

Information is evolving on the safety of same-day discharge (SDD) after left atrial appendage occlusion (LAAO) procedures. This single-centre retrospective study evaluated the feasibility of SDD and reported on the 30-day rehospitalization rate in patients discharged same-day compared with those admitted overnight after LAAO. Key findings of this study included more than 85% of patients with LAAO were safely discharged same-day; the rate of postdischarge rehospitalization was similar in SDD patients and those admitted overnight; and approximately 1 in 10 patients who had LAAO procedures were rehospitalized within 30 days postprocedure.