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Left atrial appendage closure (LAA): a comprehensive analysis of periprocedural and long-term outcomes in elderly patients.
Session:
Sessão de Posters 03 - Arritmias cardíacas e dispositivos percutâneos no risco cardioembólico
Speaker:
Mariana Rodrigues Simões
Congress:
CPC 2024
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.6 Device Therapy - Other
Session Type:
Cartazes
FP Number:
---
Authors:
Mariana Rodrigues Simões; Gonçalo Ferraz Costa; Gonçalo Terleira Batista; Tatiana Pereira Dos Santos; Ana L. Silva; Rafaela Fernandes; Vanessa Lopes; José Luís Martins; Manuel Santos; Luís Paiva; Marco Costa; Lino Gonçalves
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Introduction: Elderly patients are an expanding and vulnerable population. When undergoing catheter based left atrial appendage closure (LAA), a comprehensive consideration of risks is crucial. </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Methods: We conducted a retrospective study at one centre, reviewing all patients who underwent catheter based LAA closure between May 2010 and December 2020. Using SPSS software, we compare periprocedural results and outcomes by the end of follow-up between elderly patients (≥ 75 years old) and younger ones. </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Results: A total of 156 patients were included. Seventy-six patients were 75 years old or older (49%). The older group had a median age of 79(ID=5) years, and the other 68(ID=8) years. Among the elderlies, 68% were men <em>versus</em> (<em>vs</em>) 60% in the younger group. The elderly group presented a median follow-up time of 424(ID=1075) days<em> vs </em>564(ID=1159)days, (p=0,420). Among the elderlies, forty-eight had permanent atrial fibrillation (AF), seven persistent AF and twenty-one paroxysmal AF. Elderly patients had more hyperlipidaemia (n=48<em> vs</em> 44) and coronary artery disease (n=14 <em>vs</em> 9), but differences were not significant. The elderly group had higher median creatinine values at in-hospital admission: 1,07(ID=0,51) <em>vs </em>0,87(ID=0,41) mg/dl, p=0,001. The mean CHA<sub>2</sub>DS<sub>2</sub>VASC and HASBLED scores were higher among older patients (4,85±1,17 <em>vs </em>3,78±1,45 and 3,28±0,92 <em>vs </em>2,83±1,22, respectively) but with no significant differences. Ten elderlies underwent the LAA occlusion after a thrombotic event despite correct use of oral anticoagulation. More elderly patients closed the LAA after a major bleeding (n=49 vs 39, p=0,048; OR: 1,908 (CI 1,003-3,627)). Other reasons for LAA occlusion included frequent minor bleeding. The procedure was equally successful (96% vs 96%, p=0.936). Related to in-hospital major complications, 7 elderly presented events (2 vascular access complications, 3 cardiac tamponades, 1 type-2 myocardial infarction and 1 major bleeding) against 1 event (cardiac tamponade) in the younger group, p=0,031 OR: 8,01 (0,96-66,8). By the end of follow up, only 3 patients in both groups had experienced a stroke (p=0.931). Five elderly patients (<em>vs </em>4 younger) presented a major bleeding, (p=0.736). Nineteen of the thirty-one patients who died were elderlies (p=0,092). There were no differences observed between cardiovascular and non-cardiovascular deaths between groups (p=0.862 and p=0.265, respectively).</span></span></p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Conclusion: Elderly patients were associated with more periprocedural non-fatal major complications but no differences in long term outcomes. </span></span></p>
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