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Multicenter Study
. 2024 Jul 1;27(3):220-227.
doi: 10.4103/aca.aca_14_24. Epub 2024 Jul 4.

Anesthetic Choice for Percutaneous Transcatheter Closure of the Left Atrial Appendage: A National Anesthesia Clinical Outcomes Registry Analysis

William Hickman  1 , Rachel S Dada  2 , Dylan Thibault  3 , Christina Gibson  4 , Scott Heller  3 , Vikrant Jagadeesan  5 , Heather K Hayanga  4
Affiliations
Multicenter Study

Anesthetic Choice for Percutaneous Transcatheter Closure of the Left Atrial Appendage: A National Anesthesia Clinical Outcomes Registry Analysis

William Hickman et al. Ann Card Anaesth. .

Abstract

Context: Left atrial appendage closure (LAAC) was developed as a novel stroke prevention alternative for patients with atrial fibrillation, particularly for those not suitable for long-term oral anticoagulant therapy. Traditionally, general anesthesia (GA) has been more commonly used primarily due to the necessity of transesophageal echocardiography.

Aims: Compare trends of monitored anesthesia care (MAC) versus GA for percutaneous transcatheter LAAC with endocardial implant and assess for independent variables associated with primary anesthetic choice.

Settings and design: Multi-institutional data collected from across the United States using the National Anesthesia Clinical Outcomes Registry.

Material and methods: Retrospective data analysis from 2017-2021.

Statistical analysis used: Independent-sample t tests or Mann-Whitney U tests were used for continuous variables and Chi-square tests or Fisher's exact test for categorical variables. Multivariate logistic regression was used to assess patient and hospital characteristics.

Results: A total of 19,395 patients underwent the procedure, and 352 patients (1.8%) received MAC. MAC usage trended upward from 2017-2021 (P < 0.0001). MAC patients were more likely to have an American Society of Anesthesiologists (ASA) physical status of≥ 4 (33.6% vs 22.89%) and to have been treated at centers in the South (67.7% vs 44.2%), in rural locations (71% vs 39.5%), and with lower median annual percutaneous transcatheter LAAC volume (102 vs 153 procedures) (all P < 0.0001). In multivariate analysis, patients treated in the West had 85% lower odds of receiving MAC compared to those in the Northeast (AOR: 0.15; 95% CI 0.03-0.80, P = 0.0261).

Conclusions: While GA is the most common anesthetic technique for percutaneous transcatheter closure of the left atrial appendage, a small, statistically significant increase in MAC occurred from 2017-2021. Anesthetic management for LAAC varies with geographic location.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Flow diagram of data retrieved from the National Anesthesia Clinical Outcomes Registry (NACOR)
Figure 2
Figure 2
Trends of anesthesia management type for left atrial appendage closure over time. P Value corresponds to anesthetic type compared to general anesthesia
See this image and copyright information in PMC

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