Percutaneous left atrial appendage occlusion in mitral valve disease: A Nationwide Readmission Database analysis.

BACKGROUND: Percutaneous left atrial appendage occlusion (LAAO) has emerged as a non-pharmacologic alternative to oral anticoagulation in reducing stroke risk in AF patients. However, patients with mitral valve disease (MVD), who are expected to have a significantly greater risk of left atrium (LA) thrombus formation and embolic stroke were excluded from randomized trials examining percutaneous LAAO. To address this gap, we present a national registry analysis of the use of LAAO among patients with MVD. METHODS: Using the National Readmissions Database, we performed a retrospective review of all hospitalizations for LAAO identified between September 2015 and November 2019. Of these, patients with ICD-10 codes for MVD were identified. Propensity matched (PSM) analysis was used to compare patients with MVD with a matched sample of patients undergoing LAAO with non-valvular AF. Outcomes examined included all-cause mortality, stroke, major bleeding, pericardial effusion (PE), and tamponade. RESULTS: 51,540 patients who underwent LAAO without a history of MVD and 3777 with a history of MVD were identified. Crude analysis demonstrated the odds of mortality, PE, and cardiac tamponade during index hospitalization to be higher in the MVD group. The length of stay and cost of index hospitalization were also slightly greater for the MVD group. A sample of 7649 patients (MVD: 3777 MVD and no MVD: 3872) were selected for PSM analysis with similar comorbidities across the two groups. In the PSM comparison, MVD was associated with higher risk of PE. The MVD group had a slightly higher rate of readmissions the association with PE remained at 30-day readmission (OR: 2.099 [1.360-3.238], p-value: <0.001). CONCLUSION: To our knowledge, this is the first study examining the use of LAAO among MVD patients. Our findings suggest that patients with MVD who underwent LAAO had a higher risk of post-procedural PE without an increase in mortality, stroke, or major bleeding. These results provide a rationale for considering LAAO as part of the stroke prevention strategy among patients with valvular AF.

Coronary Orbital Atherectomy Through Newly Deployed Left Main Coronary Stent.

Percutaneous coronary intervention (PCI) in complex, calcified coronary lesions can be assisted with orbital atherectomy (OA). OA is generally avoided when there are lesions amendable to OA distal to a newly deployed stent due to the risk of device-stent interaction, burr entrapment, and stent avulsion. We present a case documenting the successful passage of an OA system through a recently deployed left main stent to prepare a chronically occluded left anterior descending for PCI.

Efficacy of 3D-multidetector computed tomography and fluoroscopy fusion for percutaneous left atrial appendage occlusion procedures.

INTRODUCTION: We studied the impact of the use of three-dimensional multidetector computed tomography (3D-MDCT) and fluoroscopy fusion on percutaneous left atrial appendage occlusion (LAAO) procedures in relation to procedure time, contrast volume, fluoroscopy time, and total radiation. METHODS: This was a single-center, prospective, single-blinded, randomized control trial. Patients meeting criteria for LAAO were randomized to undergo LAAO with the WATCHMAN FLXTM device with and without 3D-MDCT-fluoroscopy fusion guidance using a prespecified protocol using computed tomography angiography for WATCHMAN FLXTM sizing, moderate sedation, and intracardiac echocardiography for procedural guidance. RESULTS: Overall, 59 participants were randomly assigned to the fusion (n = 33) or no fusion (n = 26) groups. The median (interquartile range) age was 79 (75-83) years, 24 (41%) were female, and 55 (93%) were Caucasian. The median CHA2 DS2 VASc and HASBLED scores were 5 (4-6) and 3 (3-4), respectively. At the time of the study, 51 (53%) patients were on a direct acting oral anticoagulant. There were no significant differences between the fusion and no fusion groups in procedure time (52.4 ± 15.4 vs. 56.8 ± 19.5 min, p = .36), mean contrast volume used (33.8 ± 12.0 vs. 29.6 ± 11.5 mls, p = .19), mean fluoroscopy time (31.3 ± 9.9 vs. 28.9 ± 8.7 min, p = .32), mean radiation dose (1177 ± 969 vs. 1091 ± 692 mGy, p = .70), and radiation dose product curve (23.9 ± 20.5 vs. 35.0 ± 49.1 Gy cm2 , p = .29). There was no periprosthetic leak in the two groups in the immediate 1-month postprocedure follow-up periods. CONCLUSIONS: There was no significant difference with and without 3D-MDCT-fluoroscopy fusion in procedure time, contrast volume use, radiation dose, and radiation dose product.

Delayed Pericardial Effusion Following Left Atrial Appendage Closure: A 5-Year Single-Center Experience.

BACKGROUND: Though uncommon, pericardial effusion and cardiac tamponade are serious complications of left atrial appendage closure (LAAC). There are few data related to delayed pericardial effusions from this procedure. METHODS: This is a single-center prospective analysis of 369 patients who underwent LAAC from December 2016 to March 2022 at a large teaching hospital. We compared patients who developed effusion (n = 5) to patients who did not (n = 364) to determine if there were any factors that predispose patients to developing acute (AEs) or delayed pericardial effusions (DEs). We compared patient characteristics, procedural data, and complications. Unadjusted, stepwise multivariate logistic regression was performed. RESULTS: A total of 369 patients underwent LAAC. Of these, 5 patients (1.4%) developed pericardial effusion. Patients in both groups (pericardial effusion vs non-effusion) had similar patient and procedural characteristics. Patients in both groups were older (mean age, 78.4 ± 7.8 years in the effusion group vs 76.3 ± 8.5 years in the non-effusion group; P=.50) and white (60% in the effusion group vs 90.1% in the non-effusion group). CHA2DS2-VASc (4.2 ± 1.1 vs 4.5 ± 1.4; P=.67) and HAS-BLED (3.4 ± 0.5 vs 3.7 ± 0.9; P=.53) scores were similar in the effusion group vs the non-effusion group, respectively. Gastrointestinal bleeding was the most common procedural indication in both groups (80% in the effusion group vs 53.6% in the non-effusion group; P=.23). The majority of the patients in both groups had successful implantation in the first attempt, with the 27-mm device the most commonly used size. There was no significant difference in procedural duration (67 minutes in the effusion group vs 75 minutes in the non-effusion group; P=.16). Among patients who received the Watchman Legacy device, 2 patients developed AEs and no patients had DEs. Of those receiving the Watchman FLX device, 1 patient developed AE and 2 patients developed DEs. All of the patients with effusions had successful recovery. CONCLUSION: In this 5-year, single-center experience, DEs were uncommon and potentially related to LAA device anchor microperforation. No statistically significant risk factors predisposing patients to pericardial effusions were identified in our analysis.