Department of Internal Medicine, Central Michigan University, College of Medicine, Mount Pleasant, Michigan, USA.
Department of Internal Medicine, Monmouth Medical Center, Long Branch, New Jersey, USA.
Pacing Clin Electrophysiol. 2022 Jul;45(7):866-873. doi: 10.1111/pace.14537. Epub 2022 Jun 9.
Chronic kidney disease (CKD) and end-stage renal disease are considered independent risk factors for developing atrial fibrillation (AF). Percutaneous occlusion of left atrial appendage (LAAC) using WATCHMAN device is a widely accepted alternative to anticoagulation therapy to prevent ischemic stroke in AF in patients who are not candidates for anticoagulation. There is limited data regarding the utilization and periprocedural safety of this intervention in patients with CKD/ESRD.
We retrospectively reviewed all hospitalizations from 2016 to 2017 with (ICD-10) procedure diagnosis code of LAA closure using WATCHMAN procedure with and without a secondary diagnosis of CKD/ESRD in acute-care hospitals across the United States using the national inpatient sample. Demographic variables (gender, race, income, hospital characteristics, medical comorbidities) were collected and compared. The primary outcomes were inpatient mortality, hospital length, and cost of stay.
There were over 71 million discharges included in the combined 2016 and 2017 NIS database. Sixteen thousand five hundred five hospitalizations were for adult patients with a procedure code for LAA closure via watchman procedure. Of 16,505 patients, 3245 (19.66%) had CKD and ESRD. There was no statistically significant difference in mortality, length, and cost of stay in patients with and without CKD/ESRD. There were no statistically significant differences in periprocedural cerebrovascular accidents in both groups.
Patients with and without ESRD/CKD who undergo LAA occlusion with Watchman have similar procedure related, in-hospital mortality, and complications.
慢性肾脏病（CKD）和终末期肾病（ESRD）被认为是发生心房颤动（AF）的独立危险因素。经皮左心耳（LAA）封堵术（WATCHMAN 装置）是一种广泛接受的抗凝替代疗法，可预防非抗凝治疗的 AF 患者发生缺血性卒中。关于该介入治疗在 CKD/ESRD 患者中的应用和围手术期安全性的数据有限。
我们回顾性分析了 2016 年至 2017 年期间美国全国住院患者样本中（ICD-10）采用 WATCHMAN 术式进行 LAA 封堵术的所有住院患者（伴有或不伴有 CKD/ESRD 的次要诊断）。收集并比较了人口统计学变量（性别、种族、收入、医院特征、合并症）。主要结局是住院死亡率、住院时间和住院费用。
在 2016 年和 2017 年的 NIS 数据库中，共纳入超过 7100 万次出院。有 16505 次住院是为接受 WATCHMAN 术式 LAA 封堵术的成年患者进行的。在 16505 名患者中，有 3245 名（19.66%）患有 CKD 和 ESRD。有和没有 CKD/ESRD 的患者在死亡率、住院时间和住院费用方面无统计学差异。两组患者在围手术期内发生的脑血管意外也无统计学差异。
接受 WATCHMAN 行 LAA 封堵术的 ESRD/CKD 患者与非 ESRD/CKD 患者在手术相关死亡率和并发症方面无显著差异。
