Percutaneous left atrial appendage closure using a modified single-operator-technician approach under deep sedation: A single-center experience

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2 Pub Date : 2024-12-01 DOI:10.1016/j.hroo.2024.10.004

Alejandro José Quiroz Alfaro MD , Noah E. Russell DO , Ruhul Munshi MD , Waleed Hassan MD , James E. Stone MD , Elsheikh M. Abdelrahim MD , Karl J. Crossen MD , Karthik Venkatesh Prasad MD

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Abstract

Background

Historically, percutaneous transcatheter left atrial appendage closure (LAAC) has been performed under general anesthesia (GA) with transesophageal echocardiographic images obtained by a noninvasive cardiologist and usually requires an overnight hospital stay. Alternatively, we present our single-center experience performing LAACs under deep sedation (DS), employing an echocardiographic technician instead of a noninvasive cardiologist, and expediting same-day discharge. Mid- to long-term outcomes were also evaluated with follow-up imaging at a 45-day visit.

Objective

The purpose of this study was to demonstrate the safety, feasibility, and outcomes of our single-operator-technician LAAC approach.

Methods

A total of 150 patients, with elevated CHA₂DS₂-VASc scores (a mean of 4 points), underwent transesophageal echocardiography–guided LAAC using the WATCHMAN FLX (Boston Scientific, Marlborough, MA) device under DS.

Results

The mean age of patients was 78 years. Seventy-six (51%) were men. One hundred forty-seven patients (98%) had the LAAC device successfully implanted, and 145 (97%) were discharged on the same day. Nine patients (6%) required conversion from DS to GA. Only 5 patients (4%) had complications during the procedure. None of the patients died or had complications from DS. During the 45-day follow-up visit, one patient had a significant peridevice leak (maximum diameter ≥ 5 mm) and another patient had device-related thrombosis.

Conclusion

Our novel single-operator-technician approach under DS is safe and feasible. Implementing protocols to simplify the traditional 2-operator approach under GA by using DS and an echocardiography technician as well as incorporating same-day discharge could make LAACs more widely available and potentially reduce procedural costs.

查看原文本刊更多论文

深度镇静下经皮左心耳闭合采用改良的单手术技术方法：单中心经验。

背景：历史上，经皮经导管左心耳闭合（LAAC）是在全身麻醉（GA）下进行的，由无创心脏病专家获得经食管超声心动图图像，通常需要住院一晚。另外，我们介绍了在深度镇静（DS）下进行laac的单中心经验，使用超声心动图技术人员而不是无创心脏病专家，并加快当天出院。在45天的随访中，还通过随访成像评估了中长期结果。目的：本研究的目的是证明我们的单一操作人员-技术人员LAAC方法的安全性、可行性和结果。方法：共有150例CHA2DS2-VASc评分升高（平均4分）的患者，在DS下使用WATCHMAN FLX （Boston Scientific, Marlborough， MA）设备接受经食管超声心动图引导的LAAC。结果：患者平均年龄78岁。76人（51%）为男性。147例患者（98%）成功植入LAAC装置，145例患者（97%）当日出院。9例（6%）患者需要从DS转为GA。只有5例（4%）患者在手术过程中出现并发症。没有患者死亡或出现退行性椎体滑移的并发症。在45天的随访中，1例患者出现明显的器械外漏（最大直径≥5mm），另1例患者出现器械相关血栓形成。结论：我们的单刀手术方法是安全可行的。通过使用DS和超声心动图技术人员以及合并当日出院，在GA下简化传统的2操作员方法的实施方案可以使laac更广泛地应用，并可能降低手术成本。

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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