Percutaneous left atrial appendage occlusion: A South African experience.

IF 1.5 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Samj South African Medical Journal Pub Date : 2022-04-01 DOI:10.7196/samj.2022.v112i4.16077

A. Dippenaar, J. Saaiman, P. Brink, M. Heradien, P. van der Bijl

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引用次数: 0

Abstract

BACKGROUND Atrial fibrillation (AF) is associated with all-cause mortality, heart failure and non-fatal stroke, and thromboprophylaxis is traditionally provided with oral anticoagulants (OACs). Percutaneous left atrial appendage occlusion (LAAO) with a dedicated device is an alternative approach to thromboprophylaxis in patients with AF who are: (i) intolerant to OACs (e.g. life-threatening haemorrhage); (ii) non-adherent to OACs; or (iii) at a high bleeding risk with OACs. Non-inferiority of LAAO compared with OACs was demonstrated in e.g. the WATCHMAN Left Atrial Appendage System for Embolic Protection in Patients With Atrial Fibrillation (PROTECT AF) trial. Only very limited data are available on percutaneous LAAO in South Africa (SA), and no local outcome data have been reported. OBJECTIVES To compare the safety and efficacy outcomes of an SA percutaneous LAAO programme with larger international series. METHODS All patients undergoing percutaneous LAAO from 2013 to 2020 at a single centre (SAEndovascular, Kuils River Netcare Hospital, SA) were included from an ongoing registry. Survival analysis was performed with the Kaplan-Meier method. RESULTS Of 101 LAAO recipients (mean (standard deviation) age 77 (10) years, 64% male) analysed, 90 (90%) had permanent AF, 1 (1%) persistent AF and 9 (9%) paroxysmal AF. The most common indication for LAAO was previous severe bleeding (n=23; 23%). The mean device size was 23 (3) mm and the procedural success rate was 98%. After a median (interquartile range) follow-up of 21 (5 - 41) months, 6 patients (6%) experienced stroke or all-cause mortality. Four patients (4%) had a life-threatening procedural complication (tamponade n=2 (2%) and device embolisation n=2 (2%)). These outcomes are comparable to large international series, e.g. PROTECT AF. CONCLUSIONS The safety and efficacy outcomes of an SA percutaneous LAAO programme were comparable to large international series. A successful percutaneous LAAO programme is feasible in a southern African context.

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经皮左心耳闭塞:南非经验。

房颤(AF)与全因死亡率、心力衰竭和非致死性卒中相关，血栓预防传统上是口服抗凝剂(OACs)。专用装置经皮左心耳闭塞(LAAO)是房颤患者预防血栓形成的另一种方法，这些患者:(i)对OACs不耐受(例如危及生命的出血);(ii)不遵守oac;或(iii) OACs患者出血风险高。LAAO与OACs相比的非劣效性已在WATCHMAN左心房附件系统用于房颤患者栓塞保护(PROTECT AF)试验中得到证实。在南非(SA)，只有非常有限的经皮LAAO数据，没有当地结果数据的报道。目的比较SA经皮LAAO方案与大型国际系列方案的安全性和有效性。方法:2013年至2020年在单一中心(SAEndovascular, Kuils River Netcare Hospital, SA)接受经皮LAAO的所有患者均纳入正在进行的登记。生存分析采用Kaplan-Meier法。结果101例LAAO受者(平均(标准差)年龄77(10)岁，男性64%)中，90例(90%)为永久性房颤，1例(1%)为持续性房颤，9例(9%)为阵发性房颤。LAAO最常见的指征是既往严重出血(n=23;23%)。器械平均尺寸为23 (3)mm，手术成功率为98%。在中位(四分位数范围)随访21个月(5 - 41)后，6名患者(6%)发生中风或全因死亡。4例(4%)患者有危及生命的手术并发症(2例填塞(2%)和2例器械栓塞(2%))。结论SA经皮LAAO方案的安全性和有效性与大型国际系列相当。一个成功的经皮LAAO规划在南部非洲是可行的。

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

Samj South African Medical Journal 医学-医学：内科

CiteScore

3.00

自引率

4.50%

发文量

175

审稿时长

4-8 weeks

期刊介绍： The SAMJ is a monthly peer reviewed, internationally indexed, general medical journal. It carries The SAMJ is a monthly, peer-reviewed, internationally indexed, general medical journal publishing leading research impacting clinical care in Africa. The Journal is not limited to articles that have ‘general medical content’, but is intending to capture the spectrum of medical and health sciences, grouped by relevance to the country’s burden of disease. This will include research in the social sciences and economics that is relevant to the medical issues around our burden of disease The journal carries research articles and letters, editorials, clinical practice and other medical articles and personal opinion, South African health-related news, obituaries, general correspondence, and classified advertisements (refer to the section policies for further information).