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. 2023 Jun 13:10:1172005.
doi: 10.3389/fcvm.2023.1172005. eCollection 2023.

Left atrial appendage occlusion in the absence of intraprocedural product specialist monitoring: is it time to proceed alone? Results from a multicenter real-world experience

Davide Margonato  1 , Vincenzo Rizza  1 , Giacomo Ingallina  1 , Alberto Preda  2 , Francesco Ancona  1 , Martina Belli  1 , Cosmo Godino  3 , Eustachio Agricola  1 , Paolo Della Bella  2 , Carmelo Grasso  4 , Marco Contarini  5 , Patrizio Mazzone  2
Affiliations

Left atrial appendage occlusion in the absence of intraprocedural product specialist monitoring: is it time to proceed alone? Results from a multicenter real-world experience

Davide Margonato et al. Front Cardiovasc Med. .

Abstract

Background: Percutaneous left atrial appendage occlusion (LAAO) presents many technical complex features, and it is often performed under the intraprocedural surveillance of a product specialist (PS). Our aim is to assess whether LAAO is equally safe and effective when performed in high-volume centers without PS support.

Methods: Intraprocedural results and long-term outcome were retrospectively assessed in 247 patients who underwent LAAO without intraprocedural PS monitoring between January 2013 and January 2022 at three different hospitals. This cohort was then matched to a population who underwent LAAO with PS surveillance. The primary end point was all-cause mortality at 1 year. The secondary end point was a composite of cardiovascular mortality plus nonfatal ischemic stroke occurrence at 1 year.

Results: Of the 247 study patients, procedural success was achieved in 243 patients (98.4%), with only 1 (0.4%) intraprocedural death. After matching, we did not identify any significant difference between the two groups in terms of procedural time (70 ± 19 min vs. 81 ± 30 min, p = 0.106), procedural success (98.4% vs. 96.7%, p = 0.242), and procedure-related ischemic stroke (0.8% vs. 1.2%, p = 0.653). Compared to the matched cohort, a significant higher dosage of contrast was used during procedures without specialist supervision (98 ± 19 vs. 43 ± 21, p < 0.001), but this was not associated with a higher postprocedural acute kidney injury occurrence (0.8% vs. 0.4%, p = 0.56). At 1 year, the primary and the secondary endpoints occurred in 21 (9%) and 11 (4%) of our cohort, respectively. Kaplan-Meier curves showed no significant difference in both primary (p = 0.85) and secondary (p = 0.74) endpoint occurrence according to intraprocedural PS monitoring.

Conclusions: Our results show that LAAO, despite the absence of intraprocedural PS monitoring, remains a long-term safe and effective procedure, when performed in high-volume centers.

Keywords: atrial fibrillation; cardiovascular mortality; embolic prevention; intraprocedural monitoring; left atrial appendage closure.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Procedure-related outcome and events.
Figure 2
Figure 2
One-year survival free from all-cause death stratified by product specialist supervision during LAAO. LAAO, left atrial appendage occlusion.
Figure 3
Figure 3
One-year survival free from the secondary composite endpoint stratified by product specialist supervision during LAAO. LAAO, left atrial appendage occlusion.
See this image and copyright information in PMC

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