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Published on: February 26, 2013
Left atrial appendage closure in patients with chronic kidney disease: results from the German multicentre LAARGE
Christian Fastner1, Johannes Brachmann2, Thorsten Lewalter3
1First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
Insights
Chronic kidney disease (CKD) patients undergoing left atrial appendage closure (LAAC) had a higher risk profile but experienced safe device implantation. LAAC effectively prevented strokes in CKD patients, despite increased bleeding risks in some cases.
Area of Science:
- Cardiology
- Nephrology
- Interventional Cardiology
Background:
- Chronic kidney disease (CKD) is common in atrial fibrillation patients.
- CKD is linked to higher complication rates after cardiac interventions.
- The impact of CKD on left atrial appendage closure (LAAC) outcomes is not well understood.
Purpose of the Study:
- To evaluate the safety and effectiveness of LAAC in patients with CKD.
- To determine if CKD influences periprocedural complications and long-term outcomes after LAAC.
Main Methods:
- A prospective, non-randomized registry (LAARGE) was used.
- LAAC was performed using standard commercial devices with a one-year follow-up.
- CKD was defined as eGFR < 60 mL/min/1.73 m², with subgroup analysis for eGFR < 15, 15-29, and 30-59 mL/min/1.73 m².
Main Results:
- 48% of patients had CKD, with higher comorbidity scores (CHA₂DS₂-VASc, HAS-BLED).
- Implantation success was high (97.9%) across all eGFR groups; periprocedural complications were infrequent.
- Stroke-free survival was lower in CKD patients (82.0% vs. 93.0%), with severe non-fatal bleeding observed only in CKD patients.
Conclusions:
- LAAC is safe and effective for stroke prevention in CKD patients, regardless of CKD stage.
- CKD patients have an increased cardiovascular risk profile but benefit from LAAC.
- Careful monitoring for bleeding complications is warranted in CKD patients undergoing LAAC.
Objectives:
Chronic kidney disease (CKD) is associated with an increased complication rate after cardiac interventions. Although CKD has a high prevalence among atrial fibrillation patients, the impact of CKD on periprocedural complications and the outcome after an interventional left atrial appendage closure (LAAC) is unclear. The present study, therefore, aimed to investigate whether CKD influences the procedure's effectiveness and safety.
Methods:
LAARGE is a prospective, non-randomised registry. LAAC was conducted with different standard commercial devices, and the follow-up period was one year. CKD was defined by an eGFR < 60 mL/min/1.73 m2, and subgroups were further analysed (i.e. eGFR < 15, 15-29, and 30-59 mL/min/1.73 m2, respectively).
Results:
Two hundred ninety-nine of 623 patients (48.0%) revealed a CKD. The prevalence of cardiovascular comorbidity, CHA2DS2-VASc score (4.9 vs. 4.2), and HAS-BLED score (4.3 vs. 3.5) was significantly higher in CKD patients (each p < 0.001). Implantation success was similarly high across all GFR groups (97.9%). Periprocedural MACCE (0.7 vs. 0.3%), and other major complications (4.7 vs. 3.7%) were comparably infrequent. Survival free of stroke was significantly lower among CKD patients within 1 year (82.0 vs. 93.0%; p < 0.001; consistent after adjustment for confounding factors), without significant accentuation in advanced CKD (i.e. eGFR < 30 mL/min/1.73 m2; p > 0.05 vs. eGFR 30-59 mL/min/1.73 m2). Non-fatal strokes were absolutely infrequent during follow-up (0 vs. 1.1%). Severe non-fatal bleedings were observed only among CKD patients (1.4 vs. 0%; p = 0.021).
Conclusions:
Despite an increased cardiovascular risk profile of CKD patients, device implantation was safe, and LAAC was associated with effective stroke prevention across all CKD stages.
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