Implant success and safety of left atrial appendage occlusion in end stage renal disease patients: Peri-procedural outcomes from an Italian dialysis population

Genovesi, Simonetta; Slaviero, Giorgio; Porcu, Luca; Casu, Gavino; Bertoli, Silvio; Sagone, Antonio; Pieruzzi, Federico; Rovaris, Giovanni; Buskermolen, Monique; Danna, Paolo; Montoli, Alberto; Oreglia, Jacopo; Contaldo, Gina; Mazzone, Patrizio

doi:10.1016/j.ijcard.2018.03.083

Cited by 24 publications

(23 citation statements)

References 19 publications

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“…To date, the evidence of percutaneous LAAO in hemodialysis patients is scarce, as only two studies have been specifically addressed to this population. The first one was an Italian study by Genovesi et al, with a cohort of 50 patients. In this study, they reported a successful implant of the devices in all the patients, with no deaths or major adverse events at 30 days, and only three peri‐procedural minor bleeding events in the access site, and two nonsignificant (2.5 and 3 mm) postprocedure para‐prosthetic leaks.…”

Section: Discussioncontrasting

confidence: 79%

“…There are no established guidelines about the duration of DAPT in hemodialysis patients after a percutaneous LAAO since the experience is scarce. The mean duration in our series was greater than those reported in the two mentioned studies (3 months, vs a range of 1‐3 months and a mean of 1.5 months). Although our sample of patients is small, with a mean of 3 months of DAPT, no thrombosis of the device was observed in any of the control TEE at 3 months.…”

Section: Discussionmentioning

confidence: 99%

“…There are several devices and methods, but the most commonly used are the Watchman Device (Boston Scientific, Marlborough, MA, USA) and the Amplatzer‐Amulet Cardiac Plug Device (St. Jude Medical Inc, St. Paul, MN, USA) (Figure ). It is a relatively simple and safe procedure in the general population, but the evidence of its use in patients on hemodialysis is scarce, and to date only two studies have been addressed specifically to this population …”

Section: Introductionmentioning

confidence: 99%

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Percutaneous left atrial appendage closure, a safe alternative to anticoagulation for patients with nonvalvular atrial fibrillation and end‐stage renal disease on hemodialysis: A single center experience

et al. 2019

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The evidence about the effectiveness and safety of oral anticoagulation in patients on hemodialysis is conflicting and scarce. Percutaneous left atrial appendage occlusion (LAAO) has demonstrated to be a valid alternative therapeutic option for stroke prevention in patients with nonvalvular atrial fibrillation (NVAF). The aim of this study is to present the outcomes of percutaneous LAAO in patients with end-stage renal disease (ESRD) on hemodialysis and NVAF in our center. We conducted a retrospective review of clinical records, demographics, LAAO procedure, complications, and outcomes of patients with NVAF and ESRD on hemodialysis who underwent a percutaneous LAAO in our centerIn the period of the study, eight patients with ESRD on hemodialysis underwent a percutaneous LAAO in our center. The overall mean age was 67.5 years (range 56-81; SD ± 7.2). All patients had permanent NVAF. The total mean dialysis duration was 8.49 years (range 0.83-14.8; SD ± 6.2). The mean CHA2DS2-VASc and HAS-BLED scores were high (4.75 [SD ± 1.16] and 4.62 [SD ± 0.91], respectively).All patients had history of a major hemorrhagic event (BARC Score ≥3). Most patients (n = 6) showed left ventricular hypertrophy, and the average LVEF was 54% (SD ± 6.5). All devices were implanted successfully. Postprocedural antithrombotic regimen prescribed was based on antiplatelet therapy. No deaths, cardioembolic events, or major bleeding (according to the BARC scale) were reported during a mean follow-up of 14.24 months (SD ± 9.44). Percutaneous LAAO could be of particular interest in patients with NVAF and CKD in hemodialysis. Further studies will be necessary to confirm this hypothesis. K E Y W O R D Satrial fibrillation, bleeding, end-stage renal disease, hemodialysis, percutaneous left atrial appendage closure

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Section: Discussioncontrasting

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Percutaneous left atrial appendage closure, a safe alternative to anticoagulation for patients with nonvalvular atrial fibrillation and end‐stage renal disease on hemodialysis: A single center experience

et al. 2019

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“…In the study by Genovesi et al, a total of 50 patients with terminal renal failure who underwent interventional LAA occlusion were examined. The preliminary results showed a good outcome after 30 days without death, stroke or bleeding …”

Section: Discussionmentioning

confidence: 90%

Risk stratification in patients undergoing interventional left atrial appendage occlusion—Prognostic impact of EuroSCORE II

Gotzmann

Choudhury

Hogeweg

et al. 2020

Clinical Cardiology

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Background: Interventional closure of the left atrial appendage (LAA) is an alternative option to stroke prophylaxis, particularly in multimorbid patients with a high risk of bleeding under oral anticoagulation. Due to the multiple comorbidities, the prognosis of patients is reduced, and the clinical benefit of the procedure is therefore questionable in the individual patient.Hypothesis: The present study aims to identify independent preprocedural risk factors to improve risk stratification in these highly selected patients. Methods: This study consecutively included 128 patients who received an interventional LAA occlusion with Amplatzer device (St Jude Medical, St Paul, Minnesota). The preinterventional risk assessment was performed with the logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) II. The primary endpoint was all-cause mortality. Secondary endpoints were thromboembolic events and severe bleeding.Results: During a follow-up of 781 ± 498 days the primary endpoint (all-cause mortality) was reached in 35 patients (27%). The only independent predictor of mid-term mortality was a logistic EuroSCORE II > 2% (Hazard risk [HR] 4.55, confidence interval [CI] 1.599-12.966, P = .005). In our study, 33 patients (26%) suffered from endstage renal disease which was not associated with increased mortality (P = .371), increased thromboembolic events (P = .475), or severe bleeding (P = .613). Conclusions:In patients undergoing interventional LAA occlusion, preprocedural assessment of logistic EuroSCORE II provide independent prognostic information.This parameter might help to improve risk stratification in these highly selected patients. In contrast, terminal renal failure was not associated with a significantly worse outcome. K E Y W O R D Sinterventional left atrial appendage occlusion, logistic EuroSCORE II, mid-term mortality, risk stratification

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“…Имеются единичные сообщения и одноцентровые исследования об имплантации этих устройств у пациентов с ХБП, как альтернативы антикоагулянтной терапии [30,31]. В настоящее время идет рандомизированное исследование Left Atrial Appendage Occlusion vs. Usual Care in Patients With Atrial Fibrillation and Severe Chronic Kidney Disease (WatchAFIB), которое, возможно, позволит уточнить показания к использованию этих устройств в этой группе пациентов [32].…”

Section: таблица 3 использование антиаритмических препаратов и препаunclassified

Atrial fibrillation in patients with chronic kidney disease

Melnikov

Yashin

2020

Vestnik aritmologii

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Implant success and safety of left atrial appendage occlusion in end stage renal disease patients: Peri-procedural outcomes from an Italian dialysis population

Cited by 24 publications

References 19 publications

Percutaneous left atrial appendage closure, a safe alternative to anticoagulation for patients with nonvalvular atrial fibrillation and end‐stage renal disease on hemodialysis: A single center experience

Percutaneous left atrial appendage closure, a safe alternative to anticoagulation for patients with nonvalvular atrial fibrillation and end‐stage renal disease on hemodialysis: A single center experience

Risk stratification in patients undergoing interventional left atrial appendage occlusion—Prognostic impact of EuroSCORE II

Atrial fibrillation in patients with chronic kidney disease

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