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Published on: February 26, 2013
Effectiveness and Safety of an Outpatient Program for Percutaneous Left Atrial Appendage Occlusion
Fabián Blanco-Fernández1,2,3, Pablo J Antúnez-Muiños1,2,3, Jean C Núñez-García4
1Department of Cardiology, Hospital Universitario de Salamanca, 37007 Salamanca, Spain.
Insights
A same-day discharge program for left atrial appendage occlusion (LAAO) is safe and effective for patients with atrial fibrillation. This approach reduces hospital stays without compromising patient outcomes compared to conventional methods.
Area of Science:
- Cardiology
- Interventional Cardiology
- Structural Heart Disease
Background:
- Left atrial appendage occlusion (LAAO) offers an alternative to oral anticoagulation for stroke prevention in nonvalvular atrial fibrillation.
- Advancements in LAAO devices and imaging have improved success rates and reduced complications.
- Same-day discharge protocols are emerging in structural heart interventions but lack detailed study for LAAO.
Purpose of the Study:
- To evaluate the safety and efficacy of an outpatient, same-day discharge protocol for LAAO.
- To compare the outcomes of an outpatient LAAO program against the conventional treatment approach.
Main Methods:
- A retrospective, non-randomized single-center study included 262 patients undergoing LAAO.
- Patients were divided into a conventional protocol (CP) group (n=131) and an outpatient protocol (OP) group (n=131).
- The primary endpoint was a composite of MACCE, cardiac tamponade, vascular complications, or emergency department visits within 30 days.
Main Results:
- The overall LAAO success rate was 99.6% with a 2.29% periprocedural complication rate.
- No significant difference was found in the primary composite endpoint between the CP and OP groups (6.1% vs. 3.0%, p=0.24), even after propensity score matching.
- The outpatient protocol significantly decreased the length of hospital stay (p < 0.01).
Conclusions:
- A same-day discharge LAAO program is a safe, effective, and feasible strategy.
- This outpatient approach reduces hospital length of stay, potentially offering clinical and economic advantages.
- LAAO as an outpatient procedure demonstrates favorable outcomes comparable to conventional inpatient management.
Background:
Left atrial appendage occlusion (LAAO) is a safe and effective alternative to oral anticoagulation for thromboprophylaxis in patients with nonvalvular atrial fibrillation. Technological development in devices and imaging techniques, as well as accumulated experience, have increased procedural success rates and decreased complications. Same-day discharge protocols have been proposed in the field of structural heart disease, but this approach has not been studied in detail for the LAAO procedure.
Aim:
The aim of this study is to assess the safety and efficacy of an outpatient program for LAAO when compared to the conventional treatment approach.
Methods:
We present a retrospective, non-randomized single-center study of 262 consecutive patients undergoing LAAO. Patients were divided into two groups, the first (n = 131) followed a conventional protocol (CP), and the second (n = 131) an outpatient protocol (OP). The primary composite endpoint comprised MACCE (death, stroke, and bleeding), cardiac tamponade, vascular complication, or attendance in the emergency department after hospital discharge at 30 days.
Results:
The overall success rate was 99.6%, with a periprocedural complication rate of 2.29%. With regards to the CP versus OP group, there were no differences between incidences of the primary composite endpoint (6.1% PC vs. 3.0% PA, p = 0.24), or after an analysis, with propensity score matching. No differences were observed in the individual endpoints. There was a decrease in hospital length of stay in the same-day discharge group (p < 0.01).
Conclusions:
A same-day discharge LAAO program is safe, effective, and feasible when compared to the conventional strategy. Moreover, it reduces hospital length of stay, which might have clinical and economic benefits.
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