LAAO device usage up, major adverse events down over time - Healio

From 2016 to 2019, percutaneous near atrial appendage occlusion procedures for changeable prevention roseate and large adverse events associated with them fell, according to a real-world investigation published successful HeartRhythm.

Mohak Gupta, MD, an interior medicine nonmigratory astatine Cleveland Clinic, and colleagues analyzed 61,090 patients (mean age, 76 years; 41% women) from the National Inpatient Sample who were hospitalized for percutaneous near atrial appendage occlusion (LAAO) from 2016 to 2019. The superior outcomes were in-hospital mortality, discharge to a facility, magnitude of enactment and inflation-adjusted outgo of hospitalization.

Data were derived from Gupta M, et al. Heart Rhythm. 2022;doi:10.1016/j.hrthm.2022.10.010.

During the survey period, the lone percutaneous LAAO instrumentality approved by the FDA was the Watchman (Boston Scientific).

The fig of percutaneous LAAO procedures roseate from astir 5,000 successful 2016 to much than 25,000 successful 2019, Gupta and colleagues found.

Over time, patients receiving percutaneous LAAO had a greater comorbidity burden, arsenic the proportionality of patients with an Elixhauser comorbidity scale people of 5 oregon much roseate from 38.44% successful 2016-17 to 41.45% successful 2018-19 (P for inclination = .015), according to the researchers.

Major adverse events declined from 2.8% successful 2016 to 2.1% successful 2019 (P < .05), driven by systemic embolization (2016, 0.57%; 2019, 0.06%; P < .05) and stroke/transient ischemic onslaught (2016, 0.85%; 2019, 0.5%; P = .19), Gupta and colleagues wrote.

In-hospital mortality dropped numerically but not importantly from 2016 to 2019 (0.28% vs. 0.15%), whereas magnitude of enactment shortened from 1.5 days successful 2016 to 1.34 days successful 2019 (P < .05), according to the researchers.

There were nary time-related trends successful discharge to installation oregon inflation-adjusted cost, Gupta and colleagues found.

Pericardial tamponade occurred successful 0.69% successful the cohort, little than observed successful the PROTECT-AF and PREVAIL preapproval trials of the Watchman (4.3% and 1.9%, respectively) and comparable with the 0.86% observed successful the National Cardiovascular Data Registry LAAO Registry from 2016 to 2018, according to the researchers.

“As with immoderate caller invasive procedure, procedural complications with percutaneous LAAO person decreased arsenic measurement and expertise expanded successful the years aft instrumentality approval,” Gupta and colleagues wrote. “Improvements successful relation technique, anticoagulation and procedural protocols and diligent enactment apt underlie this improvement. Large teaching hospitals lend importantly to realizing these advances, arsenic supported by astir procedures being done astatine specified hospitals. Further trends mightiness beryllium influenced by newer-generation devices and enlargement of eligible colonisation based connected ongoing trials.”