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Published on: February 26, 2013
Safety and Efficacy of Combining Left Atrial Appendage Occlusion With Another Cardiac Procedure
Mahmoud Ismayl1, Hasaan Ahmed2, James V Freeman3
1Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Insights
Combining left atrial appendage occlusion (LAAO) with other cardiac procedures showed similar safety and effectiveness compared to isolated LAAO. However, combined procedures were linked to increased costs and specific complications.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Clinical outcomes of combined left atrial appendage occlusion (LAAO) and other cardiac procedures remain underexplored.
- Previous research has not systematically evaluated the safety and efficacy of LAAO performed concurrently with other cardiac interventions.
Purpose of the Study:
- To assess the safety and efficacy of combining LAAO with other cardiac procedures compared to isolated LAAO.
- To identify potential differences in clinical outcomes, complications, and costs between combined and isolated LAAO procedures.
Main Methods:
- Retrospective cohort study utilizing the 2016-2020 National Inpatient Sample database.
- Comparison of patients undergoing LAAO with concomitant cardiac procedures versus isolated LAAO.
- Analysis of risk-adjusted major adverse cardiovascular events (MACEs), in-hospital mortality, complications, length of stay (LOS), and total costs.
Main Results:
- The study included 88,910 LAAO encounters; 1.4% involved concomitant procedures.
- Risk-adjusted analysis revealed similar MACEs, in-hospital mortality, and most complications (stroke, acute kidney injury, bleeding, transfusion, vascular injury) between groups.
- Combined procedures were associated with similar LOS but higher costs compared to isolated LAAO. Specific subgroups (AF ablation, TAVR) showed increased risks for certain complications.
Conclusions:
- Combining LAAO with other cardiac interventions demonstrated comparable MACEs and LOS to isolated LAAO.
- Concomitant procedures were associated with higher overall costs and an increased frequency of certain complications.
- Subgroup analyses indicated specific risks, such as heart block with AF ablation and stroke/vascular injury with TAVR.
Background:
Clinical outcomes of left atrial appendage occlusion (LAAO) combined with other cardiac procedures have not been previously examined.
Objectives:
This study sought to evaluate the safety and efficacy of combining LAAO with other cardiac procedures vs isolated LAAO.
Methods:
We conducted a retrospective cohort study using the 2016 to 2020 National Inpatient Sample database to compare patients undergoing LAAO combined with another cardiac procedure vs isolated LAAO. Outcomes included risk-adjusted major adverse cardiovascular events (MACEs), in-hospital mortality, major complications, length of stay (LOS), and total costs.
Results:
The total cohort included 88,910 weighted encounters, of which 1,225 (1.4%) involved concomitant cardiac procedures. After risk adjustment, patients in the concomitant procedure group had similar odds of MACEs (adjusted OR: 1.82; 95% CI: 0.94-2.74); in-hospital mortality; and complications including stroke, acute kidney injury, major bleeding, blood transfusion, and vascular injury. They also had similar LOS (1 day vs 1 day; P = 0.32) and higher costs ($44,723 vs $32,364; P < 0.01) compared with isolated LAAO but shorter LOS (1 day vs 2 days; P < 0.01) and lower costs ($51,552 vs $63,170; P = 0.04) compared with LAAO with sequential procedures. In subgroup analyses, concomitant atrial fibrillation/atrial flutter ablation had higher adjusted odds of heart block (P < 0.01), and concomitant transcatheter aortic valve replacement had higher adjusted odds of stroke (P = 0.02) and vascular injury (P < 0.01).
Conclusions:
In this retrospective observational study, combining LAAO with another cardiac intervention appeared to be associated with similar MACEs and LOS. However, certain complications appeared to be more frequent, and the cost was higher with combined procedures.
