ABSTRACT
INTRODUCTION AND OBJECTIVES: Advanced chronic kidney disease (A-CKD) combined with atrial fibrillation increases the risk of both thrombogenic and bleeding events. Left atrial appendage occlusion (LAAO) may be an alternative to oral anticoagulation to prevent thromboembolic events. We aimed to evaluate the outcomes of LAAO in patients with A-CKD. METHODS: Comparison at long-term follow-up of patients diagnosed with and without A-CKD (eGFR<30 mL/min/1.73 m2 ) who underwent LAAO between 2009 and May 2022. RESULTS: Five hundred seventy-three patients were included. Eighty-one (14%) were diagnosed with A-CKD. There were no differences in sex, age, and cardiovascular risk factors, except for diabetes which was more frequent in patients with A-CKD. The control group had higher rates of stroke, both ischemic and hemorrhagic. There were no differences in the CHA2 DS2 -VASc score, although A-CKD patients had a higher bleeding risk according to the HASBLED scale. Global procedural success was 99.1%. At follow-up, there were no differences in stroke rate: at 1-year (HR: 1.22, IC-95%: 0.14-10.42, p = 0.861); at 5-years (HR: 0.60, IC-95%: 0.08-4.58, p = 0.594). Although bleeding events were higher in the A-CKD group, no differences were found in major bleeding (defined BARC ≥ 3) at 1-year (HR: 1.34, IC-95%: 0.63-2.88, p = 0.464) or at 5-years follow-up (HR: 1.30, IC-95%: 0.69-2.48, p = 0.434). Mortality rate at 5 years was higher in the A-CKD patients (HR: 1.84, IC-95%: 1.18-2.87, p = 0.012). CONCLUSIONS: LAAO is an effective and safe treatment in A-CKD patients to prevent ischemic events and bleeding. This strategy could be an alternative to oral anticoagulation in this high-risk group of patients.
Subject(s)
Atrial Appendage , Atrial Fibrillation , Renal Insufficiency, Chronic , Stroke , Humans , Follow-Up Studies , Atrial Appendage/diagnostic imaging , Treatment Outcome , Stroke/diagnosis , Stroke/etiology , Stroke/prevention & control , Hemorrhage/chemically induced , Hemorrhage/prevention & control , Renal Insufficiency, Chronic/complications , Renal Insufficiency, Chronic/diagnosis , Atrial Fibrillation/complications , Atrial Fibrillation/diagnosis , Atrial Fibrillation/therapy , Anticoagulants/adverse effectsABSTRACT
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.
ABSTRACT
BACKGROUND: Paravalvular leak occurs in 5-17% of patients following surgical valve replacement, more often in mitral position. The prognosis without treatment is poor. Percutaneous device closure represents an alternative to repeat surgery. The objective of this work is to evaluate the medium and long-term results in the percutaneous closure of PVL in mitral prosthesis. METHODS: This observational study is based on a retrospective registry including consecutive mitral PVL cases undergoing percutaneous closure at a single tertiary-care center from April 2010 to December 2020. The safety and efficacy results of the procedure, at 90 days and in the long term, were analyzed. Also, predictors of procedure failure and long-term events were identified. RESULTS: A total of 128 consecutive mitral paravalvular leak closure procedures were included. Technical success was achieved in 115 (89.8%) procedures. The presence of multiple PVLs was the sole factor that independently predicted procedural failure. Median follow-up of our sample was 41.8 months (mean 47.7 ± 35.7 months). Underlying hemolytic anemia as the indication for PVL closure, a recent admission for decompensated HF, and lack of improvement in functional class emerged as consistent predictors of MACE and death during long-term follow-up, while lack of procedural success during the first PVL procedure and chronic kidney disease were also associated with MACE during follow-up. CONCLUSIONS: Percutaneous mitral PVL closure displayed high technical and procedural success rates, with an acceptable safety profile, in a high-risk population. Percutaneous mitral PVL closure achieved an improvement in short- and long-term functional class and a reduction of hemolysis in the vast majority of patients. In addition, long-term survival in our study was good, in particular for patients undergoing successful PVL closure procedures.
Subject(s)
Heart Valve Prosthesis , Mitral Valve Insufficiency , Mitral Valve Stenosis , Thrombosis , Heart Atria , Heart Valve Prosthesis/adverse effects , Humans , Mitral Valve/diagnostic imaging , Mitral Valve/surgery , Thrombosis/diagnostic imaging , Thrombosis/etiology , Tomography, X-Ray ComputedSubject(s)
Aortic Valve Stenosis , Bioprosthesis , Heart Valve Prosthesis Implantation , Heart Valve Prosthesis , Transcatheter Aortic Valve Replacement , Aortic Valve/diagnostic imaging , Aortic Valve/surgery , Aortic Valve Stenosis/diagnostic imaging , Aortic Valve Stenosis/surgery , Heart Valve Prosthesis Implantation/adverse effects , Humans , Prosthesis Design , Transcatheter Aortic Valve Replacement/adverse effects , Treatment OutcomeABSTRACT
Abstract Atrial fibrillation (AF) is an increasing health care problem associated with thromboembolic risk about 5% per year, with high mortality and morbidity when associated to stroke. Oral anticoagulants (OAC) are the treatment of choice for preventing ischemic stroke in patients with nonvalvular atrial fibrillation (NVAF). However, these drugs are associated with an increased risk of serious complications such an intracranial hemorrhage (ICH). In this context percutaneous closure of the left atrial appendage (LAA) is an effective therapeutic alternative to OACs, with an increasing success rate. Novel devices might allow or facilitate the procedure in some anatomically and technically complicated cases. Two patients with a complex morphology of the LAA, in which the LAmbre (Lifetech Scientific [Shenzhen] Co. Ltd.) device was implanted with good technical and clinical results are presented.
Subject(s)
Humans , Female , Aged, 80 and over , Atrial Fibrillation/therapy , Cardiac Catheterization/instrumentation , Atrial Appendage/diagnostic imaging , Septal Occluder Device , Atrial Fibrillation/diagnostic imaging , Angiography , Echocardiography , Cardiac Catheterization/methods , Stroke/prevention & controlSubject(s)
Atrial Appendage , Atrial Fibrillation , Cardiac Catheterization , Heart Atria/diagnostic imaging , Prosthesis Fitting/methods , Septal Occluder Device , Surgery, Computer-Assisted/methods , Aged , Atrial Appendage/diagnostic imaging , Atrial Appendage/pathology , Atrial Appendage/surgery , Atrial Fibrillation/complications , Atrial Fibrillation/surgery , Cardiac Catheterization/instrumentation , Cardiac Catheterization/methods , Echocardiography, Transesophageal/methods , Female , Humans , Organ Size , Stroke/etiology , Stroke/prevention & control , Tomography, X-Ray Computed/methods , Treatment OutcomeSubject(s)
Atrial Appendage/surgery , Atrial Fibrillation/therapy , Cardiac Catheterization/instrumentation , Aged , Atrial Appendage/diagnostic imaging , Atrial Appendage/physiopathology , Atrial Fibrillation/diagnostic imaging , Atrial Fibrillation/physiopathology , Equipment Design , Female , Humans , Ligation , Treatment OutcomeSubject(s)
Atrial Appendage/diagnostic imaging , Atrial Fibrillation/therapy , Cardiac Catheterization , Conscious Sedation , Echocardiography, Doppler, Color/instrumentation , Echocardiography, Doppler, Pulsed/instrumentation , Echocardiography, Transesophageal/instrumentation , Transducers , Atrial Appendage/physiopathology , Atrial Fibrillation/diagnostic imaging , Atrial Fibrillation/physiopathology , Atrial Function, Left , Cardiac Catheterization/adverse effects , Cardiac Catheterization/instrumentation , Equipment Design , Humans , Miniaturization , Predictive Value of Tests , Retrospective Studies , Treatment OutcomeSubject(s)
Angioplasty, Balloon , Aortic Valve Stenosis/surgery , Catheterization, Peripheral , Coronary Artery Disease/therapy , Lithotripsy , Percutaneous Coronary Intervention , Peripheral Arterial Disease/therapy , Transcatheter Aortic Valve Replacement , Vascular Calcification/therapy , Aged, 80 and over , Aortic Valve Stenosis/complications , Aortic Valve Stenosis/diagnostic imaging , Coronary Artery Disease/complications , Coronary Artery Disease/diagnostic imaging , Humans , Male , Peripheral Arterial Disease/complications , Peripheral Arterial Disease/diagnostic imaging , Severity of Illness Index , Treatment Outcome , Vascular Calcification/complications , Vascular Calcification/diagnostic imagingSubject(s)
Atrial Appendage , Atrial Fibrillation/therapy , Cardiac Catheterization/instrumentation , Thrombosis/therapy , Aged , Anticoagulants/therapeutic use , Atrial Appendage/diagnostic imaging , Atrial Appendage/physiopathology , Atrial Fibrillation/complications , Atrial Fibrillation/diagnosis , Atrial Fibrillation/physiopathology , Echocardiography , Embolism/etiology , Humans , Male , Radiography, Interventional , Stroke/etiology , Thrombosis/diagnostic imaging , Thrombosis/etiology , Thrombosis/physiopathology , Treatment OutcomeABSTRACT
We present the case of a patient with a high-output fistula between the right superficial femoral artery and femoral vein after left atrial appendage closure successfully treated with a PK-Papyrus covered coronary stent using a 6F guiding catheter. To the best of our knowledge this is the first time a PK-Papyrus coronary stent has been used in this setting.
Subject(s)
Arteriovenous Fistula/surgery , Femoral Artery/surgery , Femoral Vein/surgery , Postoperative Complications/surgery , Stents , Aged, 80 and over , Arteriovenous Fistula/etiology , Female , Humans , Iatrogenic Disease , Postoperative Complications/etiology , Vascular Surgical Procedures/methodsSubject(s)
Atrial Appendage/physiopathology , Atrial Fibrillation/therapy , Cardiac Catheterization/instrumentation , Aged , Alloys , Atrial Appendage/diagnostic imaging , Atrial Fibrillation/diagnostic imaging , Atrial Fibrillation/physiopathology , Echocardiography, Three-Dimensional , Echocardiography, Transesophageal , Female , Humans , Polyesters , Prosthesis Design , Radiography, Interventional , Treatment OutcomeSubject(s)
Atrial Appendage/surgery , Atrial Fibrillation/complications , Cardiac Catheterization/methods , Cardiac Surgical Procedures/methods , Intracranial Hemorrhages/surgery , Aged, 80 and over , Atrial Appendage/diagnostic imaging , Atrial Fibrillation/diagnosis , Atrial Fibrillation/surgery , Echocardiography, Transesophageal , Female , Follow-Up Studies , Humans , Intracranial Hemorrhages/etiology , Male , Retrospective Studies , Septal Occluder Device , Treatment OutcomeSubject(s)
Coronary Stenosis/diagnostic imaging , Aged , Coronary Angiography , Coronary Artery Bypass , Coronary Stenosis/complications , Coronary Stenosis/surgery , Echocardiography , Heart Valve Prosthesis Implantation , Humans , Male , Mitral Valve Insufficiency/diagnostic imaging , Mitral Valve Insufficiency/surgery , Ventricular Dysfunction, Left/diagnostic imaging , Ventricular Dysfunction, Left/etiologyABSTRACT
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