Effect of Glomerular Filtration Rates on Outcomes Following Percutaneous Left Atrial Appendage Closure

Faroux, Laurent; Cruz-González, Ignacio; Arzamendi, Dabit; Freixa, Xavier; Nombela‐Franco, Luis; Peral, Vicente; Caneiro‐Queija, Berenice; Mangieri, Antonio; Trejo-Velasco, Blanca; Asmarats, Lluís; Regueiro, Ander; McInerney, Angela; Mas-Lladó, Caterina; Estévez‐Loureiro, Rodrigo; Laricchia, Alessandra; O’Hara, Gilles; Rodés‐Cabau, Josep

doi:10.1016/j.amjcard.2020.12.081

Cited by 9 publications

(17 citation statements)

References 21 publications

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“…Finally, HF and CKD are associated with higher risk of fluid overload in the form of pulmonary edema that could also explain these findings. Outcomes of LAA closure in patients with CKD were considered unexplored until a recent study by Faroux et al 23 The authors studied the effect of CKD on the outcomes of 1094 patients undergoing LAA closure, from which 27.4% of patients had moderate to severe CKD, defined as a glomerular filtration rate (GFR) < 45 ml/min. At 2 years follow‐up, they found that patients with CKD had a higher risk of severe bleeding events and death.…”

Section: Discussionmentioning

confidence: 99%

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Safety of left atrial appendage closure in heart failure patients

Das¹,

Lorente-Ros

et al. 2022

Cardiovasc electrophysiol

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Introduction: Left atrial appendage closure (LAAC) is an intervention aimed at stroke prevention in nonvalvular atrial fibrillation (AF). There is a three-fold increased risk of stroke in patients with concomitant presence of AF and heart failure (HF). While anticoagulation is effective, only 60% receive it. We aimed at studying the safety of LAAC in HF patients using a national all-payer database.Methods: We queried the National Inpatient Sample for the year 2016-2018 for WATCHMAN device insertion using ICD 10 procedure codes. We divided the study population into HF and non-HF groups. Outcomes were compared using appropriate statistical tests, p< .05 was considered significant.Results: 34 385 LAAC procedures were identified of which 8530 (24.8%) were done in patients with HF. The mean (SD) age of the study population was 76 (7.9) years and 42% were female. There was no difference in mean age between HF and non-HF groups. Our findings indicate that there is no difference in inpatient mortality and cardiac complications between the HF and non-HF groups. However, noncardiac complications including acute kidney injury and respiratory failure were higher in the HF group.Conclusion: LAAC appears to be a safe procedure in patients with HF. The study is limited by a short follow up period and long-term follow-up is required before definitive conclusions can be made.

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Section: Discussionmentioning

confidence: 99%

“…Second, there is recent literature that some of these baseline characteristics are associated with an increased risk of in‐hospital mortality after undergoing LAA closure. This may be due to HF itself, 17 as well as pre‐existing kidney disease 23 …”

Section: Discussionmentioning

confidence: 99%

Safety of left atrial appendage closure in heart failure patients

Das¹,

Lorente-Ros

et al. 2022

Cardiovasc electrophysiol

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“…Despite having a mainly hepatic metabolism, VKA failed to demonstrate the benefits of stroke prevention in ESRD patients: the time percentage with an international normalised ratio (INR) within the target range is lower than in patients with normal renal function. Additionally, VKA use in ESRD patients may indeed increase bleeding and stroke rates, as well as result in calcification and occlusion of cutaneous arteries 40,41 . Reduced dose regimens of NOAC (which are in part eliminated by the kidneys) are feasible OAC options for patients with severe chronic kidney disease (creatinine clearance [CrCl]=15-29 mL/min).…”

Section: End-stage Renal Diseasementioning

confidence: 99%

Percutaneous left atrial appendage closure: beyond the classic indications

Guérios¹,

Chamié²

2023

AsiaIntervention

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Percutaneous left atrial appendage closure (LAAC) has proven to be an effective alternative to oral anticoagulation (OAC) for stroke prevention in patients with non-valvular atrial fibrillation (NVAF). International guidelines traditionally recommend LAAC for NVAF patients at high thromboembolic risk and contraindication to or at high risk for OAC. However, there are many other clinical situations in which this procedure may also be beneficial. This paper discusses the potential role of LAAC in specific haemorrhagic diseases (cerebral amyloid angiopathy, age-related macular degeneration, hereditary haemorrhagic telangiectasia, and Moyamoya disease), after left atrial appendage (LAA) electrical isolation, in cases of persistent thrombus inside the LAA, in end-stage renal disease and in special groups of patients for whom low compliance and persistence to OAC may be anticipated.

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“…The resulting studies along with their references and reviews and meta-analysis were manually screened to identify potential original studies. Our search retrieved 13 studies focused on left atrial appendage closure (LAAC) in patients with an eGFR of <60 ml/min per 1.72 m 2 (18 –30). Of these, five studies analyzed outcomes in patients with ESKD on dialysis (26 –30).…”

Section: Rationale For Nonpharmacologic Treatment Of Atrial Fibrillat...mentioning

confidence: 99%

“…Besides the limitations of nonrandomization and observational nature of the studies, the lack of representation of patients on RRT due to small numbers is a pervasive across studies done on patients with CKD. Faroux et al .’s paper was the only one among these studies to include 47 patients on HD (25). Their reported rates of device-related thrombosis were not influenced by kidney dysfunction.…”

Section: Laao In Nonvalvular Atrial Fibrillation and Ckdmentioning

confidence: 99%