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

Abstract

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.

Midterm follow‐up after computed tomography angiography planned left atrial appendage closure

“…Although there are no guidelines regarding the superiority of various CTA sizing strategies, we have previously described excellent results using area-based diameter for device sizing. 8,21 In this series, our procedural success (defined as effective device deployment and release) of 99.1% compared very favorably to prior published studies that used a TEEbased strategy. [22][23][24] The mean number of devices used per patient in our present study also compares favorably to prior published data.…”

“…While an undersized device may lead to device migration and incomplete closure, 20 an oversized device may cause appendage injury, device embolization, or tissue erosion. Although there are no guidelines regarding the superiority of various CTA sizing strategies, we have previously described excellent results using area‐based diameter for device sizing 8,21 . In this series, our procedural success (defined as effective device deployment and release) of 99.1% compared very favorably to prior published studies that used a TEE‐based strategy 22–24 .…”

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

“…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 and outcomes of same‐day discharge (SDD).…”

“…Male sex and younger age were associated with a greater likelihood for SDD. The main study limitation is the follow‐up data on the peridevice leak, as acknowledged by the authors 3 …”

“…The main study limitation is the follow-up data on the peridevice leak, as acknowledged by the authors. 3 Advancements in device technology, improvement in implant techniques, cardiac computed tomography-based preplanning have generally led to safer implants, lower peridevice leak, and reduced adverse outcomes. With the advent of new LAAO programs and increasing volume of cases at established sites, there has been an interest in optimizing the efficiency of the LAAO procedure; this has been primarily driven by strategies for SDD.…”