Percutaneous Left Atrial Appendage Closure in Patients with Non-Valvular Atrial Fibrillation and End-Stage Renal Disease on Hemodialysis: A Case Series

Autor: Elena Basabe, José C. De La Flor, Virginia López de la Manzanara, Luis Nombela-Franco, Carlos Narváez-Mejía, Leónidas Cruzado, Daniel Villa, Rocío Zamora, Manuel Tapia, Miguel Ángel Sastre, Edurne López Soberón, José A. Herrero Calvo, Alfonso Suárez, David Martí Sánchez
Jazyk: angličtina
Rok vydání: 2024
Předmět:
Zdroj: Medicina, Vol 60, Iss 2, p 231 (2024)
Druh dokumentu: article
ISSN: 1648-9144
1010-660X
DOI: 10.3390/medicina60020231
Popis: Non-valvular atrial fibrillation (NVAF) is the most common cardiac arrhythmia in the general population, and its prevalence increases among patients with chronic kidney disease (CKD) undergoing hemodialysis. This population presents high risk of both hemorrhagic and thrombotic events, with little evidence regarding the use of oral anticoagulation treatment (OAT) and multiple complications arising from it; however, stroke prevention with percutaneous left atrial appendage closure (LAAC) is an alternative to be considered. We retrospectively describe the safety and efficacy of percutaneous LAAC in eight patients with NVAF and CKD on hemodialysis during a 12-month follow-up. The mean age was 78.8 years (range 64–86; SD ± 6.7), and seven patients were male. The mean CHA2DS2-VASC and HAS-BLED scores were high, 4.8 (SD ± 1.5) and 3.8 (SD ± 1.3), respectively. Seventy-five percent of the patients were referred for this intervention due to a history of major bleeding, with gastrointestinal bleeding being the most common type, while the remaining twenty-five percent of the patients were referred because of a high risk of bleeding. The percutaneous LAAC procedure was successfully completed in 100% of the patients, with complete exclusion of the appendage without complications or leaks exceeding 5 mm. There was one death not related to the procedure four days after the intervention. Among the other seven patients, no deaths, cardioembolic events or major bleeding were reported during the follow-up period. In our sample, percutaneous LAAC appears to be a safe and effective alternative to anticoagulation in patients with NVAF and CKD on hemodialysis.
Databáze: Directory of Open Access Journals
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