PO-716-08 REAL WORLD CLINICAL OUTCOMES OF LEFT ATRIAL APPENDAGE OCCLUSION DEVICE IN THE OCTOGENARIAN AND NONAGENARIAN PATIENTS

Abstract

Few trials evaluated real world clinical outcomes in patients with atrial fibrillation receiving the Watchman device for left atrial appendage closure. In the recent Ewolution trial, mean age of patients was 73.4 + 8 years. Although few patients > 80 years were included, the safety and efficacy in terms of clinical outcomes of stroke, bleeding and mortality in the octogenarian and nonagenarian population specifically has not been reported in real world setting. To examine peri-procedure outcomes and short-term outcomes at 6 weeks and 3-6 months in terms of stroke, bleeding, peri-device leaks, device related thrombosis and mortality. We conducted a retrospective chart review of all patients that were greater than or equal to 80 years old at the time of Watchman device implantation from January 1, 2018 through October 31st 2021 at the University of Texas Health SA and Methodist Hospital of San Antonio. We examined the history and procedural data, 6 week, 3-month and 6-month outcomes. Primary outcomes were ischemic CVA, major bleeding, and all-cause mortality. Secondary outcomes were device leaks and device related thrombus. We examined a cohort of 40 patients with a mean age of 87+ 3.5 years. Females comprised 78% with 50% Caucasians, 37.5% Hispanics, and 12.5% African Americans. The average CHA2DS2Vasc Score was 5.15 + 1.1 and the average HAS-BLED Score was 3.7+ 1.1. Mean EF was 56 + 11.6%. Ninety percent of patients were on direct oral anticoagulant pre-procedure. The most common indications for implantation were fall risk (37.5%) and bleeding risk (37.5%). Two patients had peri-device leak < 5mm immediately post procedure. There was one groin hematoma. One case was aborted due to anatomy of the appendage. There were no other peri-procedural complications. All patients were on a DOAC post implant for 6 weeks. TEE performed at 6 weeks revealed that one patient had a new small leak and one patient had a device related thrombus. At 6 weeks and at 3-6 months, there was no incidence of CVA. One patient died of unrelated cause and one patient was placed on hospice for cancer at 6 months. Left atrial appendage occlusion with Watchman device seems to be safe and effective in octogenarian and nonagenarian population.