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.

Autor: Golzarian H; Department of Internal Medicine, Internal Medicine Residency Program, Mercy Health-St. Rita's Medical Center, Lima, Ohio, USA., Pasley BA; Department of Internal Medicine, Internal Medicine Residency Program, Mercy Health-St. Rita's Medical Center, Lima, Ohio, USA., Shah SR; Department of Internal Medicine, Internal Medicine Residency Program, Mercy Health-St. Rita's Medical Center, Lima, Ohio, USA., Thiel AM; Department of Cardiology, Structural Heart & Intervention Center, Bon Secours Mercy Health-St. Rita's Medical Center, Lima, Ohio, USA., Knous M; Department of Cardiology, Structural Heart & Intervention Center, Bon Secours Mercy Health-St. Rita's Medical Center, Lima, Ohio, USA., Kleman AC; Department of Cardiology, Structural Heart & Intervention Center, Bon Secours Mercy Health-St. Rita's Medical Center, Lima, Ohio, USA., Saum JL; Department of Cardiology, Structural Heart & Intervention Center, Bon Secours Mercy Health-St. Rita's Medical Center, Lima, Ohio, USA., Hempfling GL; Department of Cardiology, Structural Heart & Intervention Center, Bon Secours Mercy Health-St. Rita's Medical Center, Lima, Ohio, USA., Otto M; Department of Cardiothoracic & Vascular Surgery, Bon Secours Mercy Health-St. Rita's Medical Center, Lima, Ohio, USA., Otto T; Department of Cardiothoracic & Vascular Surgery, Bon Secours Mercy Health-St. Rita's Medical Center, Lima, Ohio, USA., Racer L; Department of Cardiology, Structural Heart & Intervention Center, Bon Secours Mercy Health-St. Rita's Medical Center, Lima, Ohio, USA., Martz D; Department of Cardiology, Structural Heart & Intervention Center, Bon Secours Mercy Health-St. Rita's Medical Center, Lima, Ohio, USA., Gemmel DJ; Department of Internal Medicine, Graduate Medical Education Research, Bon Secours Mercy Health-St. Elizabeth Youngstown Hospital, Youngstown, Ohio, USA., Laird AD; Department of Critical Care, Bon Secours Mercy Health-St. Rita's Medical Center, Lima, Ohio, USA., Cole WC; Department of Critical Care, Bon Secours Mercy Health-St. Rita's Medical Center, Lima, Ohio, USA., Parsa P; Department of Anesthesia, Bon Secours Mercy Health-St. Rita's Medical Center, Lima, Ohio, USA., Imm C; Department of Anesthesia, Bon Secours Mercy Health-St. Rita's Medical Center, Lima, Ohio, USA., Patel SM; Department of Cardiology, Structural Heart & Intervention Center, Bon Secours Mercy Health-St. Rita's Medical Center, Lima, Ohio, USA.
Jazyk: angličtina
Zdroj: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions [Catheter Cardiovasc Interv] 2024 Aug; Vol. 104 (2), pp. 330-342. Date of Electronic Publication: 2024 May 12.
DOI: 10.1002/ccd.31073
Abstrakt: 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 CHA 2 D 2 SVASc 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.
(© 2024 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC.)
Databáze: MEDLINE
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