Division of Cardiology, University Hospitals, Cleveland, OH, United States of America.
Department of Cardiology, Thomas Jefferson Hospitals, Philadelphia, PA, United States of America.
Cardiovasc Revasc Med. 2024 Jun;63:23-30. doi: 10.1016/j.carrev.2024.01.007. Epub 2024 Jan 15.
Percutaneous left atrial appendage occlusion (LAAO) has emerged as a non-pharmacologic alternative to oral anticoagulation in reducing stroke risk in AF patients. However, patients with mitral valve disease (MVD), who are expected to have a significantly greater risk of left atrium (LA) thrombus formation and embolic stroke were excluded from randomized trials examining percutaneous LAAO. To address this gap, we present a national registry analysis of the use of LAAO among patients with MVD.
Using the National Readmissions Database, we performed a retrospective review of all hospitalizations for LAAO identified between September 2015 and November 2019. Of these, patients with ICD-10 codes for MVD were identified. Propensity matched (PSM) analysis was used to compare patients with MVD with a matched sample of patients undergoing LAAO with non-valvular AF. Outcomes examined included all-cause mortality, stroke, major bleeding, pericardial effusion (PE), and tamponade.
51,540 patients who underwent LAAO without a history of MVD and 3777 with a history of MVD were identified. Crude analysis demonstrated the odds of mortality, PE, and cardiac tamponade during index hospitalization to be higher in the MVD group. The length of stay and cost of index hospitalization were also slightly greater for the MVD group. A sample of 7649 patients (MVD: 3777 MVD and no MVD: 3872) were selected for PSM analysis with similar comorbidities across the two groups. In the PSM comparison, MVD was associated with higher risk of PE. The MVD group had a slightly higher rate of readmissions the association with PE remained at 30-day readmission (OR: 2.099 [1.360-3.238], p-value: <0.001).
To our knowledge, this is the first study examining the use of LAAO among MVD patients. Our findings suggest that patients with MVD who underwent LAAO had a higher risk of post-procedural PE without an increase in mortality, stroke, or major bleeding. These results provide a rationale for considering LAAO as part of the stroke prevention strategy among patients with valvular AF.
经皮左心耳封堵术（LAAO）已成为减少 AF 患者中风风险的非药物替代方案，优于口服抗凝治疗。然而，预计左心房（LA）血栓形成和栓塞性中风风险显著增加的二尖瓣疾病（MVD）患者被排除在经皮 LAAO 的随机试验之外。为了解决这一差距，我们报告了一项关于 MVD 患者使用 LAAO 的全国登记分析。
我们使用全国再入院数据库，对 2015 年 9 月至 2019 年 11 月期间确定的所有 LAAO 住院患者进行回顾性审查。其中，确定了具有 MVD ICD-10 代码的患者。采用倾向评分匹配（PSM）分析比较 MVD 患者与接受 LAAO 的非瓣膜性 AF 匹配样本患者。检查的结果包括全因死亡率、中风、大出血、心包积液（PE）和心脏压塞。
共确定了 51540 例无 MVD 病史且 3777 例有 MVD 病史的患者。在原始分析中，MVD 组的死亡率、PE 和心脏压塞的可能性更高。MVD 组的住院时间和住院费用也略高。选择了 7649 例患者（MVD：3777 例 MVD 和 3872 例无 MVD）进行 PSM 分析，两组患者的合并症相似。在 PSM 比较中，MVD 与 PE 风险增加相关。MVD 组的再入院率略高，但与 PE 相关的 30 天再入院率仍保持较高水平（OR：2.099 [1.360-3.238]，p 值：<0.001）。
据我们所知，这是第一项研究左心耳封堵术在 MVD 患者中的应用。我们的研究结果表明，接受 LAAO 的 MVD 患者在没有增加死亡率、中风或大出血的情况下，术后发生 PE 的风险更高。这些结果为在瓣膜性 AF 患者中考虑将 LAAO 作为预防中风策略的一部分提供了依据。
