HCA Northside Hospital, St Petersburg, Florida.
UT Houston, MD Anderson Cancer Center, Houston, Texas.
Catheter Cardiovasc Interv. 2021 Apr 1;97(5):912-916. doi: 10.1002/ccd.29376. Epub 2020 Nov 16.
Left atrial appendage occlusion (LAAO) using Watchman device has become a world-wide, well-established therapeutic alternative to chronic systemic oral anticoagulation in patient who are at high-risk of bleeding with paroxysmal (PAF) or chronic atrial fibrillation (Afib). Currently, LAAO procedures are performed under general anesthesia (GA) and patients stay overnight post procedure in the United States. We aimed to present the effectiveness and safety of same day discharge following LAAO under moderate conscious sedation (MCS) in patients without procedural complications.
A total of 112 patients between August 2019 and May 2020 with elevated CHA DS VASc (median score of 3) underwent transesophageal echocardiography (TEE)-guided LAAO with FDA approved Watchman (Boston Scientific, MN) under MCS and discharged home on the same day 6 hr following their post procedural transthoracic echocardiogram (TTE) evaluations. All patients had next day TTE and follow up at the cardiology clinic. We prospectively evaluated clinical and procedural outcomes using medical records of these patients.
Among all the patients, the mean age was 83.5 ± 8.5 years, 45 (40%) were women. Procedural duration, device implant time and fluoroscopic times were 45 ± 8.6, 14.5 ± 7.8 and 10.2 ± 1.2 min, respectively. The median required dosage of propofol was 105 ± 2.8 mg. No complications arose from MCS. There was no need for conversion to GA in any of the patients during the procedure. All patients were able to be discharged 6 hr following their TTE evaluation post procedure. There were no procedural complications.
Same day discharge following LAAO closure seems to be safe and effective in patients without procedural complications. LAAO can also be performed safely and effectively under moderate conscious sedation. Applying moderate conscious sedation may simplify the LAAO procedure, reduce procedural time, procedural costs and hospital stay while increasing overall patient satisfaction.
使用 Watchman 装置进行左心耳封堵术（LAAO）已成为一种全球范围内广泛应用的治疗选择，适用于因阵发性（PAF）或慢性心房颤动（Afib）而存在高出血风险的患者，替代长期全身性口服抗凝治疗。目前，LAAO 手术在全身麻醉（GA）下进行，在美国，患者在手术后需留院过夜。我们旨在介绍在无手术并发症的患者中，在中度镇静（MCS）下进行日间出院的 LAAO 手术的有效性和安全性。
2019 年 8 月至 2020 年 5 月期间，共有 112 名 CHA2DS2-VASc 评分较高（中位数为 3 分）的患者接受了经食管超声心动图（TEE）引导下的 LAAO 手术，使用经美国食品和药物管理局批准的 Watchman（波士顿科学公司，MN）装置，并在术后 6 小时进行经胸超声心动图（TTE）评估后当天出院。所有患者均在次日进行 TTE 检查，并在心脏病学诊所进行随访。我们使用这些患者的病历前瞻性地评估了临床和手术结果。
在所有患者中，平均年龄为 83.5±8.5 岁，45 名（40%）为女性。手术持续时间、器械植入时间和透视时间分别为 45±8.6 分钟、14.5±7.8 分钟和 10.2±1.2 分钟。所需异丙酚剂量中位数为 105±2.8 毫克。在整个手术过程中，无患者出现 MCS 相关并发症。无患者需要在手术过程中转用 GA。所有患者均能在术后 6 小时 TTE 评估后出院。无手术并发症发生。
对于无手术并发症的患者，LAAO 术后日间出院似乎是安全且有效的。在中度镇静下也可以安全有效地进行 LAAO。应用中度镇静可能会简化 LAAO 手术，缩短手术时间、手术成本和住院时间，同时提高患者整体满意度。
