Procedure Volume and Outcomes With WATCHMAN Left Atrial Appendage Occlusion

IF 6.1 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Circulation: Cardiovascular Interventions Pub Date : 2024-06-01 DOI:10.1161/CIRCINTERVENTIONS.123.013466

Daniel J. Friedman, Chengan Du, S. Zimmerman, Zhen Tan, Zhenqiu Lin, S. Vemulapalli, Andrzej S. Kosinski, Jonathan P. Piccini, Lucy Pereira, K. Minges, K. Faridi, Fredrick A. Masoudi, Jeptha P. Curtis, James V. Freeman

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引用次数: 0

Abstract

BACKGROUND: Procedure volumes are associated with outcomes for many cardiovascular procedures, leading to guidelines on minimum volume thresholds for certain procedures; however, the volume-outcome relationship with left atrial appendage occlusion is poorly understood. As such, we sought to determine the relationship between hospital and physician volume and WATCHMAN left atrial appendage occlusion procedural success overall and with the new generation WATCHMAN FLX device. METHODS: We performed an analysis of WATCHMAN procedures (January 2019 to October 2021) from the National Cardiovascular Data Registry LAAO Registry. Three-level hierarchical generalized linear models were used to assess the adjusted relationship between procedure volume and procedural success (device released with peridevice leak <5 mm, no in-hospital major adverse events). RESULTS: Among 87 480 patients (76.2±8.0 years; 58.8% men; mean CHA2DS2-VASc score, 4.8±1.5) from 693 hospitals, the procedural success rate was 94.2%. With hospital volume Q4 (greatest volume) as the reference, the likelihood of procedural success was significantly less among Q1 (odds ratio [OR], 0.66 [CI, 0.57–0.77]) and Q2 (OR, 0.78 [CI, 0.69–0.90]) but not Q3 (OR, 0.95 [CI, 0.84–1.07]). With physician volume Q4 (greatest volume) as the reference, the likelihood of procedural success was significantly less among Q1 (OR, 0.72 [CI, 0.63–0.82]), Q2 (OR, 0.79 [CI, 0.71–0.89]), and Q3 (OR, 0.88 [CI, 0.79–0.97]). Among WATCHMAN FLX procedures, there was attenuation of the volume-outcome relationships, with statistically significant but modest absolute differences of only ≈1% across volume quartiles. CONCLUSIONS: In this contemporary national analysis, greater hospital and physician WATCHMAN volumes were associated with increased procedure success. The WATCHMAN FLX transition was associated with increased procedural success and less heterogeneity in outcomes across volume quartiles. These findings indicate the importance of understanding the volume-outcome relationship for individual left atrial appendage occlusion devices.

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WATCHMAN 左心房阑尾封堵术的手术量和效果

背景：手术量与许多心血管手术的结果有关，这导致了某些手术的最低手术量阈值指南；然而，人们对左房阑尾闭塞术的手术量与结果之间的关系知之甚少。因此，我们试图确定医院和医生的手术量与 WATCHMAN 左房阑尾闭塞术的总体成功率和新一代 WATCHMAN FLX 设备的成功率之间的关系。方法：我们对国家心血管数据登记处 LAAO 登记处的 WATCHMAN 手术（2019 年 1 月至 2021 年 10 月）进行了分析。采用三级分层广义线性模型评估手术量与手术成功率（装置释放，装置周围泄漏<5 mm，无院内重大不良事件）之间的调整关系。结果：在来自 693 家医院的 87 480 名患者（76.2±8.0 岁；58.8% 为男性；平均 CHA2DS2-VASc 评分为 4.8±1.5）中，手术成功率为 94.2%。以医院量 Q4（最大量）为参照，手术成功的可能性在 Q1（几率比 [OR]，0.66 [CI，0.57-0.77]）和 Q2（OR，0.78 [CI，0.69-0.90]）中明显较低，但在 Q3（OR，0.95 [CI，0.84-1.07]）中并不明显。以医生手术量 Q4（最大手术量）为参照，手术成功的可能性在 Q1（OR，0.72 [CI，0.63-0.82]）、Q2（OR，0.79 [CI，0.71-0.89]）和 Q3（OR，0.88 [CI，0.79-0.97]）中明显较低。在 WATCHMAN FLX 手术中，容积-结果关系有所减弱，不同容积四分位数之间的绝对差异≈1%，具有统计学意义，但差异不大。结论：在这项当代全国性分析中，医院和医生的 WATCHMAN 容量越大，手术成功率越高。WATCHMAN FLX 过渡与手术成功率的提高以及不同手术量四分位数间结果的异质性较小有关。这些研究结果表明，了解单个左房阑尾闭塞装置的容量-结果关系非常重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Circulation: Cardiovascular Interventions CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

10.30

自引率

1.80%

发文量

221

审稿时长

6-12 weeks

期刊介绍： Circulation: Cardiovascular Interventions, an American Heart Association journal, focuses on interventional techniques pertaining to coronary artery disease, structural heart disease, and vascular disease, with priority placed on original research and on randomized trials and large registry studies. In addition, pharmacological, diagnostic, and pathophysiological aspects of interventional cardiology are given special attention in this online-only journal.