Impact of conscious sedation and general anesthesia on periprocedural outcomes in Watchman left atrial appendage closure

Kleinecke, Caroline; Allakkis, Wasim; Buffle, Eric; Liu, Xiaoxia; Mohrez, Yamen; Gloekler, Steffen; Brachmann, Johannes; Schnupp, Steffen; Achenbach, Stephan; Yu, Jianghong

doi:10.5603/cj.a2020.0184

Cited by 10 publications

(10 citation statements)

References 22 publications

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“…Similar to our protocol, the use of conscious sedation instead of use of general anesthesia seems to be the common variable of successful SDD at high volume 3 . The safety and feasibility of moderate conscious sedation has been reported by numerous centers, when compared to general anesthesia, in patients undergoing LAAC 9,11,12 …”

Section: Discussionmentioning

confidence: 52%

“…3 The safety and feasibility of moderate conscious sedation has been reported by numerous centers, when compared to general anesthesia, in patients undergoing LAAC. 9,11,12 To our knowledge, this is the largest number of successful SDD for LAAC being reported. Our experience is also the only study reporting 1-year outcomes available in the literature to this point.…”

Section: Discussionmentioning

confidence: 87%

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Predictors of successful same‐day discharge and 1‐year outcomes after left atrial appendage closure

Waas

Galo

Yoon

et al. 2022

Cathet Cardio Intervent

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Background Same‐day discharge (SDD) following left atrial appendage closure (LAAC) is increasingly common but predictors of successful SDD and 1‐year clinical outcomes have not been described. Objective The purpose of this study was to explore predictors of successful SDD and report 1‐year outcomes in patients undergoing LAAC with SDD. Methods A prospective analysis was performed over a 20‐month period of 225 consecutive patients that underwent LAAC in a large, academic hospital. All patients included in the study underwent a SDD protocol. Baseline characteristics and 1‐year outcomes of patients discharged same day of the procedure versus those that required at least one overnight stay were compared. Adverse events, procedural success, and procedure times were evaluated. Results One hundred and sixty‐one patients (72%) of patients were discharged the same day and 64 patients (28%) required at least an overnight stay (non‐SDD: NSDD). NSDD patients were older and more often female. Procedure time was also longer in the NSDD group than in the SDD (63.4 vs. 55.1 min; p = 0.01). While overall procedural success rates were similar between the SDD and NSDD groups (99.4% vs. 98.4%; p = 0.39), NSDD patients had more complications (9.4% vs. 0%; p = 0.01) and higher number of devices per procedure (1.2 vs. 1.0; p = 0.01) as compared to SDD. At 1 year, there were no significant difference between the SDD and NSDD groups in stroke (1.1% vs. 0%; log‐rank p = 0.44) and all‐cause mortality (3.9% vs. 4.7%; log‐rank p = 0.70). Conclusion In this single‐center LAAC experience, female sex, older age, and longer procedure duration were associated with higher likelihood for need of overnight stay. At 1‐year follow‐up, there were no significant differences in stroke events and death rates between SDD and NSDD groups.

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Section: Discussionmentioning

confidence: 52%

Section: Discussionmentioning

confidence: 87%

Predictors of successful same‐day discharge and 1‐year outcomes after left atrial appendage closure

Waas

Galo

Yoon

et al. 2022

Cathet Cardio Intervent

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“…Recent studies have shown that LAAO can be safely performed under moderate sedation. 1,2 Moreover, due to the increase in operator experience, procedural efficiency, and improvements in LAAO device design, procedural complications have significantly reduced over time. A same-day discharge strategy in select patients may provide a safe option, improve patient satisfaction, and reduce healthcare costs.…”

Section: Introductionmentioning

confidence: 99%

Same‐day discharge for left atrial appendage occlusion procedure: A systematic review and meta‐analysis

Khan

Parmar

Bhamare

et al. 2023

Cardiovasc electrophysiol

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Introduction: Most patients undergoing a left atrial appendage occlusion (LAAO) procedure are admitted for overnight observation. A same-day discharge strategy offers the opportunity to improve resource utilization without compromising patient safety. We compared the patient safety outcomes and post-discharge complications between same-day discharge versus hospital admission (HA) (>1 day) in patients undergoing LAAO procedure.Methods: A systematic search of MEDLINE and Embase was conducted. Outcomes of interest included peri-procedural complications, re-admissions, discharge complications including major bleeding and vascular complications, ischemic stroke, all-cause mortality, and peri-device leak >5 mm. Mantel-Haenszel risk ratios (RRs) with 95% CIs were calculated.Results: A total of seven observational studies met the inclusion criteria. There was no statistically significant difference between same-day discharge versus HA

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“…TEE has been the standard approach with excellent visualization during device implantation, however, requires general anesthesia that can pose significant risks to old and frail patients who are at high risk for traumatic bleeding and sedation recovery. The approach of conscious sedation TEE has been explored and utilized in Europe for LAAO implants with excellent safety and efficacy 4 . On the contrary, ICE can be performed with moderate or local anesthesia and provides reasonable imaging quality in most cases and can be exceptionally helpful in patients who are at high risk of traumatic injury from TEE or poor candidates for general anesthesia.…”

mentioning

confidence: 99%

“…The approach of conscious sedation TEE has been explored and utilized in Europe for LAAO implants with excellent safety and efficacy. 4 On the contrary, ICE can be performed with moderate or local anesthesia and provides reasonable imaging quality in most cases and can be exceptionally helpful in patients who are at high risk of Expert Article Analysis for: Predictors of successful same-day discharge and 1-year outcomes after left atrial appendage closure traumatic injury from TEE or poor candidates for general anesthesia. ICE imaging does require a separate femoral venous large bore access and, therefore, caries a somewhat higher risk of a vascular complication.…”

mentioning

confidence: 99%

Same‐day discharge after left atrial appendage occlusion: Is ICE‐guided LAAO ready for prime time?

Khera

Dangas

2022

Cathet Cardio Intervent

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Left atrial appendage occlusion (LAAO) is an established stroke prevention strategy in carefully selected patients with nonvalvular atrial fibrillation. There are two commercially available LAAO devices in the United States-Watchman FLX (Boston Scientific) and Amulet Device (Abbott). Since its Food and Drug Administration (FDA) approval in the United States in March 2015, more than 100,000 patients have undergone LAAO with watchman device. In addition, the FDA approved the Amulet LAAO device in August 2021 and both devices have demonstrated excellent safety and efficacy outcomes in trials and registry data. 1,2 Despite the differences in device design, standard practice typically involves a short percutaneous femoral venous procedure under general anesthesia using transesophageal echocardiography (TEE) guidance for device sizing, transseptal puncture, and assessment of final implant stability. In this issue of Catheterization and Cardiovascular Interventions, Waas and coworkers 3 report data from their single-center analysis of 225 consecutive patients undergoing LAAO with a Watchman LAAO device under intracardiac echocardiography (ICE) guidance. Their study focused on exploring the predictors

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Impact of conscious sedation and general anesthesia on periprocedural outcomes in Watchman left atrial appendage closure

Cited by 10 publications

References 22 publications

Predictors of successful same‐day discharge and 1‐year outcomes after left atrial appendage closure

Predictors of successful same‐day discharge and 1‐year outcomes after left atrial appendage closure

Same‐day discharge for left atrial appendage occlusion procedure: A systematic review and meta‐analysis

Same‐day discharge after left atrial appendage occlusion: Is ICE‐guided LAAO ready for prime time?

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