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

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.