P112 CLINICAL OUTCOMES OF LEFT ATRIAL APPENDAGE OCCLUSION WITH CONSCIOUS SEDATION WITHOUT ANESTHESIOLOGIST ON SITE: RESULTS FROM A MULTICENTER RETROSPECTIVE STUDY

Abstract

Abstract Background Left atrial appendage (LAA) occlusion is an important therapeutic option to prevent cardioembolic stroke in patients with atrial fibrillation (AF) with contraindications for oral anticoagulation (OAC). It is usually performed with transesophageal echocardiography (TOE) under general anesthesia (GA). In this retrospective study we present a multicenter experience of LAA occlusion performed with conscious sedation (CS) without anesthesiologist on site. Methods We collected all the LAA occlusion procedures performed from October 2018 to May 2022. All the included patients underwent the procedure for OAC intolerance mainly due to bleeding with irreversible causes. All the procedures were performed with Watchman or Amulet LAA occluders under TOE and fluoroscopy guidance by two expert interventional cardiologists without anesthesiologist on site. CS was performed with a combination of midazolam and fentanyl. Results One hundred and fifteen patients (age 76.4 ± 7.6 year) with non–valvular AF (median CHA2DS2Vasc 4.4 ± 1.4) were included in the study. CS was performed using midazolam (mean dose 5.9 ± 2.1 mg), adding fentanyl (mean dose 52.8 ± 19.6 mcg) in case of poor tolerance of the procedure despite midazolam. Acute procedural success rate was of 99.2%. One patient suffered a cardiac tamponade, urgent necessity of cardiac surgery and died 5 days after procedure. Two patients (2.6%) had anemia with need for transfusion after interventions. A patient (0.8%) suffered from oropharynx hematoma due to TOE. One case (0,8%) of vascular access site pseudoaneurysm occurred. One case (0.8%) of device thrombosis at 3 months TOE follow–up was reported. One procedure (0.8%) result in large leak device (³5 mm), confirmed at TOE follow–up performed at 3 months follow–up. No thromboembolic complications were reported. One hundred and fourteen (99.2%) patients stopped dual antiplatelet therapy within 12 months. In a follow–up of 10 ± 9 months one case of stroke (0.8%) and one case (0.8%) of transient ischemic attack (TIA) occurred. Conclusion LAA occlusion performed under CS and without the presence of anesthesiologist in cath–lab appear to be safe and effective. It can be an attractive alternative to (GA) because of lower medical staff needed and organizational effort required. In our retrospective study the success rate and the incidence of adverse events appear to be comparable with those of previous studies on the topic of LAA occlusion