Abstract 17474: End-Stage Renal Disease is Associated With Increased Complications From Watchman Implantation: A Propensity-Score Matched Analysis From National Readmission Database

Abstract

Introduction: End-stage renal disease (ESRD) is associated with increased complications due to oral anticoagulation (OAC) use for stroke prevention in atrial fibrillation (AF). Left atrial appendage occlusion (LAAO) is indicated for patients who cannot tolerate or prefer not to use OAC but the outcomes of LAAO in ESRD has not been well studied. Methods: Using National Readmission Database January 2016-December 2017, we identified all adult AF patients who had LAAO performed in the months of January to November with no missing length of stay and/or mortality information. We excluded patients who had ablation, device implantation/revision, other form of LAAO and/or coronary artery bypass graft surgery performed during index hospitalization. 1:1 propensity score matching was performed for patients with and without ESRD based on variables shown in Table 1. The main outcome of interest was early mortality defined as mortality of index hospitalization or 30-day readmissions and index hospital complications. Results: A total of 13,790 procedures were included and of these 370 patients had history of ESRD. The baseline characteristics before and after matching are shown in table 1. After propensity score matching, ESRD group was associated with significantly higher early mortality, 30-day readmissions, systemic embolism and pericardial complications (Table 2). In the matched cohort, none of the patients had postprocedural cerebrovascular accident, transient ischemic attack, device thrombosis and device embolization. After propensity matching 2 (0.5%) developed acute kidney injury requiring hemodialysis. Conclusions: ESRD is associated with higher LOS, index hospital complications and early mortality from LAAO compared to patients without ESRD. Further studies comparing outcomes between OAC use and LAAO are warranted.