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Published on: February 26, 2013
Percutaneous left atrial appendage occlusion in mitral valve disease: A Nationwide Readmission Database analysis
Rafey Feroze1, Waqas Ullah2, Puneet Kang3
1Division of Cardiology, University Hospitals, Cleveland, OH, United States of America.
Insights
Percutaneous left atrial appendage occlusion (LAAO) in mitral valve disease (MVD) patients shows a higher risk of pericardial effusion but no increase in mortality or stroke. This suggests LAAO is a viable stroke prevention strategy for these patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Structural Heart Disease
Background:
- Percutaneous left atrial appendage occlusion (LAAO) is an alternative to anticoagulation for stroke prevention in atrial fibrillation (AF).
- Patients with mitral valve disease (MVD) were excluded from major LAAO trials, leaving a gap in understanding procedural risks and benefits in this population.
- This study analyzes the safety and efficacy of LAAO in patients with MVD using a national registry.
Purpose of the Study:
- To evaluate the outcomes of percutaneous left atrial appendage occlusion (LAAO) in patients with mitral valve disease (MVD).
- To compare the risks of stroke, mortality, bleeding, and pericardial effusion in MVD patients undergoing LAAO versus non-MVD patients.
Main Methods:
- Retrospective analysis of the National Readmissions Database (2015-2019) for LAAO hospitalizations.
- Identification of patients with MVD using ICD-10 codes.
- Propensity score matching (PSM) to compare MVD patients with a matched cohort of non-MVD patients undergoing LAAO.
Main Results:
- A total of 3,777 MVD patients and 51,540 non-MVD patients were identified.
- Crude analysis showed higher mortality, pericardial effusion (PE), and cardiac tamponade in the MVD group.
- In PSM analysis, MVD was associated with a significantly higher risk of PE (OR: 2.099, p<0.001) at 30-day readmission, but no increased risk of mortality, stroke, or major bleeding.
Conclusions:
- This is the first national registry study on LAAO in MVD patients.
- LAAO in MVD patients is associated with an increased risk of post-procedural PE but not increased mortality, stroke, or major bleeding.
- LAAO may be considered a stroke prevention strategy for patients with valvular AF and MVD.
Background:
Percutaneous left atrial appendage occlusion (LAAO) has emerged as a non-pharmacologic alternative to oral anticoagulation in reducing stroke risk in AF patients. However, patients with mitral valve disease (MVD), who are expected to have a significantly greater risk of left atrium (LA) thrombus formation and embolic stroke were excluded from randomized trials examining percutaneous LAAO. To address this gap, we present a national registry analysis of the use of LAAO among patients with MVD.
Methods:
Using the National Readmissions Database, we performed a retrospective review of all hospitalizations for LAAO identified between September 2015 and November 2019. Of these, patients with ICD-10 codes for MVD were identified. Propensity matched (PSM) analysis was used to compare patients with MVD with a matched sample of patients undergoing LAAO with non-valvular AF. Outcomes examined included all-cause mortality, stroke, major bleeding, pericardial effusion (PE), and tamponade.
Results:
51,540 patients who underwent LAAO without a history of MVD and 3777 with a history of MVD were identified. Crude analysis demonstrated the odds of mortality, PE, and cardiac tamponade during index hospitalization to be higher in the MVD group. The length of stay and cost of index hospitalization were also slightly greater for the MVD group. A sample of 7649 patients (MVD: 3777 MVD and no MVD: 3872) were selected for PSM analysis with similar comorbidities across the two groups. In the PSM comparison, MVD was associated with higher risk of PE. The MVD group had a slightly higher rate of readmissions the association with PE remained at 30-day readmission (OR: 2.099 [1.360-3.238], p-value: <0.001).
Conclusion:
To our knowledge, this is the first study examining the use of LAAO among MVD patients. Our findings suggest that patients with MVD who underwent LAAO had a higher risk of post-procedural PE without an increase in mortality, stroke, or major bleeding. These results provide a rationale for considering LAAO as part of the stroke prevention strategy among patients with valvular AF.
