Effectiveness and Safety of an Outpatient Program for Percutaneous Left Atrial Appendage Occlusion.

Autor: Blanco-Fernández F; Department of Cardiology, Hospital Universitario de Salamanca, 37007 Salamanca, Spain.; Instituto de Investigación Biomédica de Salamanca, 37007 Salamanca, Spain.; Centro de Ivestigación Biomédica en Red-Enfermedades Cardiovasculares (CIBER-CV), 37007 Salamanca, Spain., Antúnez-Muiños PJ; Department of Cardiology, Hospital Universitario de Salamanca, 37007 Salamanca, Spain.; Instituto de Investigación Biomédica de Salamanca, 37007 Salamanca, Spain.; Centro de Ivestigación Biomédica en Red-Enfermedades Cardiovasculares (CIBER-CV), 37007 Salamanca, Spain., Núñez-García JC; Hospital Universitario de Burgos, 09006 Burgos, Spain., López-Tejero S; Department of Cardiology, Hospital Universitario de Salamanca, 37007 Salamanca, Spain.; Instituto de Investigación Biomédica de Salamanca, 37007 Salamanca, Spain.; Centro de Ivestigación Biomédica en Red-Enfermedades Cardiovasculares (CIBER-CV), 37007 Salamanca, Spain., Barreira-de Sousa GJ; Department of Cardiology, Hospital Universitario de Salamanca, 37007 Salamanca, Spain.; Instituto de Investigación Biomédica de Salamanca, 37007 Salamanca, Spain.; Centro de Ivestigación Biomédica en Red-Enfermedades Cardiovasculares (CIBER-CV), 37007 Salamanca, Spain., García-Monsalvo M; Department of Cardiology, Hospital Universitario de Salamanca, 37007 Salamanca, Spain.; Instituto de Investigación Biomédica de Salamanca, 37007 Salamanca, Spain.; Centro de Ivestigación Biomédica en Red-Enfermedades Cardiovasculares (CIBER-CV), 37007 Salamanca, Spain., Antúnez-Ballesteros M; Department of Cardiology, Hospital Universitario de Salamanca, 37007 Salamanca, Spain.; Instituto de Investigación Biomédica de Salamanca, 37007 Salamanca, Spain.; Centro de Ivestigación Biomédica en Red-Enfermedades Cardiovasculares (CIBER-CV), 37007 Salamanca, Spain., Maree A; St. James's Hospital, D08 NHY1 Dublin, Ireland., González-Calle D; Department of Cardiology, Hospital Universitario de Salamanca, 37007 Salamanca, Spain.; Instituto de Investigación Biomédica de Salamanca, 37007 Salamanca, Spain.; Centro de Ivestigación Biomédica en Red-Enfermedades Cardiovasculares (CIBER-CV), 37007 Salamanca, Spain., Rodríguez-Collado J; Department of Cardiology, Hospital Universitario de Salamanca, 37007 Salamanca, Spain.; Instituto de Investigación Biomédica de Salamanca, 37007 Salamanca, Spain.; Centro de Ivestigación Biomédica en Red-Enfermedades Cardiovasculares (CIBER-CV), 37007 Salamanca, Spain., Barreiro-Pérez M; Hospital Álvaro Cunqueiro, 36213 Vigo, Spain., Díaz-Peláez E; Department of Cardiology, Hospital Universitario de Salamanca, 37007 Salamanca, Spain.; Instituto de Investigación Biomédica de Salamanca, 37007 Salamanca, Spain.; Centro de Ivestigación Biomédica en Red-Enfermedades Cardiovasculares (CIBER-CV), 37007 Salamanca, Spain., Pérez Del Villar-Moro MC; Department of Cardiology, Hospital Universitario de Salamanca, 37007 Salamanca, Spain.; Instituto de Investigación Biomédica de Salamanca, 37007 Salamanca, Spain.; Centro de Ivestigación Biomédica en Red-Enfermedades Cardiovasculares (CIBER-CV), 37007 Salamanca, Spain., Sánchez-Fernández PL; Department of Cardiology, Hospital Universitario de Salamanca, 37007 Salamanca, Spain.; Instituto de Investigación Biomédica de Salamanca, 37007 Salamanca, Spain.; Centro de Ivestigación Biomédica en Red-Enfermedades Cardiovasculares (CIBER-CV), 37007 Salamanca, Spain., Cruz-González I; Department of Cardiology, Hospital Universitario de Salamanca, 37007 Salamanca, Spain.; Instituto de Investigación Biomédica de Salamanca, 37007 Salamanca, Spain.; Centro de Ivestigación Biomédica en Red-Enfermedades Cardiovasculares (CIBER-CV), 37007 Salamanca, Spain.
Jazyk: angličtina
Zdroj: Journal of clinical medicine [J Clin Med] 2023 Oct 24; Vol. 12 (21). Date of Electronic Publication: 2023 Oct 24.
DOI: 10.3390/jcm12216728
Abstrakt: Background: Left atrial appendage occlusion (LAAO) is a safe and effective alternative to oral anticoagulation for thromboprophylaxis in patients with nonvalvular atrial fibrillation. Technological development in devices and imaging techniques, as well as accumulated experience, have increased procedural success rates and decreased complications. Same-day discharge protocols have been proposed in the field of structural heart disease, but this approach has not been studied in detail for the LAAO procedure.
Aim: The aim of this study is to assess the safety and efficacy of an outpatient program for LAAO when compared to the conventional treatment approach.
Methods: We present a retrospective, non-randomized single-center study of 262 consecutive patients undergoing LAAO. Patients were divided into two groups, the first ( n = 131) followed a conventional protocol (CP), and the second ( n = 131) an outpatient protocol (OP). The primary composite endpoint comprised MACCE (death, stroke, and bleeding), cardiac tamponade, vascular complication, or attendance in the emergency department after hospital discharge at 30 days.
Results: The overall success rate was 99.6%, with a periprocedural complication rate of 2.29%. With regards to the CP versus OP group, there were no differences between incidences of the primary composite endpoint (6.1% PC vs. 3.0% PA, p = 0.24), or after an analysis, with propensity score matching. No differences were observed in the individual endpoints. There was a decrease in hospital length of stay in the same-day discharge group ( p < 0.01).
Conclusions: A same-day discharge LAAO program is safe, effective, and feasible when compared to the conventional strategy. Moreover, it reduces hospital length of stay, which might have clinical and economic benefits.
Databáze: MEDLINE
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