Length of Stay Following Percutaneous Left Atrial Appendage Occlusion: Data from the Prospective, Multicenter Amplatzer Amulet Occluder Observational Study

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2021 Aug 10

PMID 34375347

Citations 4

Authors

Kerstin Piayda

Shazia Afzal

Jens Erik Nielsen-Kudsk

Boris Schmidt

Patrizio Mazzone

Sergio Berti

Sven Fischer

Juha Lund

Matteo Montorfano

David Hildick-Smith

Ryan Gage

Hong Zhao

Tobias Zeus

Affiliations

Soon will be listed here.

Abstract

Aims: To evaluate factors influencing the length of stay in patients undergoing percutaneous left atrial appendage occlusion (LAAO).

Methods And Results: Patient characteristics, procedural data and the occurrence of serious adverse events were analyzed from the AmplatzerTM AmuletTM Occluder Observational Study. Patients were divided into three groups: same day (S, 0day, n = 60, 5.6%) early (E, 1day, n = 526, 48.9%), regular (R, 2-3days, n = 338, 31.4%) and late (L, ≥4days, n = 152, 14.1%) discharge and followed up for 60 days. Procedure and device related SAE during the in-hospital stay (S: 0.0% vs. E: 1.0% vs. R: 2.1% vs. L: 23%, p<0.0001) were a major trigger for a prolonged in-hospital stay. Of the 37 subjects in the late discharge group with an SAE prior to discharge, cardiac or bleeding complications were the most common underlying conditions, occurring in 26 subjects. Multinomial logistic analysis only identified HAS-BLED score as an independent influencing factor (p = 0.04) for a late discharge. After 60 days, mortality tended to be greatest in the late discharge group (S: 0.0% vs. E: 1.0% vs. R: 1.2% vs. L: 3.3%, p = 0.1066).

Conclusion: Over half of the subjects receiving an Amplatzer Amulet occluder were discharged within 1 day of the implant procedure. Serious adverse events were a major trigger for a late discharge after LAAO. Increased HAS-BLED score was associated with a prolonged in-hospital stay.

Citing Articles

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References

Boersma L, Ince H, Kische S, Pokushalov E, Schmitz T, Schmidt B . Efficacy and safety of left atrial appendage closure with WATCHMAN in patients with or without contraindication to oral anticoagulation: 1-Year follow-up outcome data of the EWOLUTION trial. Heart Rhythm. 2017; 14(9):1302-1308. DOI: 10.1016/j.hrthm.2017.05.038. View

Williams T, Alsanjari O, Parker J, Gannaway A, Thomson C, Gomes A . Day-case percutaneous left atrial appendage occlusion-Safety and efficacy. Catheter Cardiovasc Interv. 2018; 92(7):1439-1443. DOI: 10.1002/ccd.27791. View

Piccini J, Sievert H, Patel M . Left atrial appendage occlusion: rationale, evidence, devices, and patient selection. Eur Heart J. 2016; 38(12):869-876. DOI: 10.1093/eurheartj/ehw330. View

Thakkar J, Vasdeki D, Tzikas A, Meier B, Saw J . Incidence, Prevention, and Management of Periprocedural Complications of Left Atrial Appendage Occlusion. Interv Cardiol Clin. 2018; 7(2):243-252. DOI: 10.1016/j.iccl.2017.12.008. View

Hindricks G, Potpara T, Dagres N, Arbelo E, Bax J, Blomstrom-Lundqvist C . 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the.... Eur Heart J. 2020; 42(5):373-498. DOI: 10.1093/eurheartj/ehaa612. View

Holmes Jr D, Kar S, Price M, Whisenant B, Sievert H, Doshi S . Prospective randomized evaluation of the Watchman Left Atrial Appendage Closure device in patients with atrial fibrillation versus long-term warfarin therapy: the PREVAIL trial. J Am Coll Cardiol. 2014; 64(1):1-12. DOI: 10.1016/j.jacc.2014.04.029. View

Gilhofer T, Inohara T, Parsa A, Walker M, Uchida N, Tsang M . Safety and Feasibility of Same-Day Discharge After Left Atrial Appendage Closure. Can J Cardiol. 2020; 36(6):945-947. DOI: 10.1016/j.cjca.2020.02.069. View

Freixa X, Cruz-Gonzalez I, Regueiro A, Nombela-Franco L, Estevez-Loureiro R, Ruiz-Salmeron R . Left Atrial Appendage Occlusion as Adjunctive Therapy to Anticoagulation for Stroke Recurrence. J Invasive Cardiol. 2019; 31(8):212-216. View

Ruiz-Nodar J, Marin F, Roldan V, Valencia J, Manzano-Fernandez S, Caballero L . Should we recommend oral anticoagulation therapy in patients with atrial fibrillation undergoing coronary artery stenting with a high HAS-BLED bleeding risk score?. Circ Cardiovasc Interv. 2012; 5(4):459-66. DOI: 10.1161/CIRCINTERVENTIONS.112.968792. View

10.

Reddy V, Doshi S, Kar S, Gibson D, Price M, Huber K . 5-Year Outcomes After Left Atrial Appendage Closure: From the PREVAIL and PROTECT AF Trials. J Am Coll Cardiol. 2017; 70(24):2964-2975. DOI: 10.1016/j.jacc.2017.10.021. View

11.

Pisters R, Lane D, Nieuwlaat R, de Vos C, Crijns H, Lip G . A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey. Chest. 2010; 138(5):1093-100. DOI: 10.1378/chest.10-0134. View

12.

Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B . 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016; 37(38):2893-2962. DOI: 10.1093/eurheartj/ehw210. View

13.

Miyasaka Y, Barnes M, Gersh B, Cha S, Bailey K, Abhayaratna W . Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projections for future prevalence. Circulation. 2006; 114(2):119-25. DOI: 10.1161/CIRCULATIONAHA.105.595140. View

14.

Holmes D, Reddy V, Turi Z, Doshi S, Sievert H, Buchbinder M . Percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrillation: a randomised non-inferiority trial. Lancet. 2009; 374(9689):534-42. DOI: 10.1016/S0140-6736(09)61343-X. View

15.

Bergmann M, Ince H, Kische S, Schmitz T, Meincke F, Schmidt B . Real-world safety and efficacy of WATCHMAN LAA closure at one year in patients on dual antiplatelet therapy: results of the DAPT subgroup from the EWOLUTION all-comers study. EuroIntervention. 2018; 13(17):2003-2011. DOI: 10.4244/EIJ-D-17-00672. View

16.

Lip G, Lowe G, Rumley A, Dunn F . Increased markers of thrombogenesis in chronic atrial fibrillation: effects of warfarin treatment. Br Heart J. 1995; 73(6):527-33. PMC: 483914. DOI: 10.1136/hrt.73.6.527. View

17.

Reddy V, Holmes D, Doshi S, Neuzil P, Kar S . Safety of percutaneous left atrial appendage closure: results from the Watchman Left Atrial Appendage System for Embolic Protection in Patients with AF (PROTECT AF) clinical trial and the Continued Access Registry. Circulation. 2011; 123(4):417-24. DOI: 10.1161/CIRCULATIONAHA.110.976449. View

18.

Sawant A, Seibolt L, Sridhara S, Rodriguez J, Distler E, Murarka S . Operator Experience and Outcomes after Transcatheter Left Atrial Appendage Occlusion with the Watchman Device. Cardiovasc Revasc Med. 2019; 21(4):467-472. DOI: 10.1016/j.carrev.2019.08.001. View

19.

Landmesser U, Schmidt B, Nielsen-Kudsk J, Lam S, Park J, Tarantini G . Left atrial appendage occlusion with the AMPLATZER Amulet device: periprocedural and early clinical/echocardiographic data from a global prospective observational study. EuroIntervention. 2017; 13(7):867-876. DOI: 10.4244/EIJ-D-17-00493. View

20.

Heeringa J, van der Kuip D, Hofman A, Kors J, van Herpen G, Stricker B . Prevalence, incidence and lifetime risk of atrial fibrillation: the Rotterdam study. Eur Heart J. 2006; 27(8):949-53. DOI: 10.1093/eurheartj/ehi825. View