Zahid Salman, Gowda Smitha, Hashem Anas, Khan Muhammad Zia, Ullah Waqas, Kaur Gurleen, Nasir Usama, Rai Devesh, Faza Nadeen N, Little Stephen H, Valderrabano Miguel, Goel Sachin S
Department of Medicine, Rochester General Hospital, Rochester, New York.
Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas.
J Soc Cardiovasc Angiogr Interv. 2022 Nov 3;1(6):100510. doi: 10.1016/j.jscai.2022.100510. eCollection 2022 Nov-Dec.
Left atrial appendage closure (LAAC) is usually performed under the guidance of transesophageal echocardiography (TEE). Data on the safety of intracardiac echocardiogram (ICE)-guided LAAC from a real-world population in the United States remain limited. In this study, the aim was to evaluate the trends and outcomes of ICE-guided LAAC procedures using the US National Inpatient Sample.
This study used the National Inpatient Sample database from quarter 4 of 2015 to 2019. We used a propensity-matched analysis and adjusted odds ratios for in-hospital outcomes/complications. A value of <.05 was considered significant.
We identified 61,995 weighted LAAC cases. Of these, 1410 patients had ICE-guided LAAC with a lower median age than the patients who had TEE-guided LAAC (75 vs 77 years; ≤ .01). The use of ICE-guided LAAC increased from 1.7% in 2015 to 2.2% in 2019 ( = .75). Major, cardiovascular, neurologic, and pulmonary complications were similar for ICE-guided and TEE-guided LAAC on adjusted analysis. On propensity-matched analysis, the overall vascular complication rates were similar. However, retroperitoneal bleeding remained significantly higher (0.7% vs 0%) with ICE. Gastrointestinal bleeding complications were more frequent in TEE-guided LAAC (3.5% vs 2.1%). The length of stay was similar for both groups (median = 1 day; = .23); however, ICE was associated with $1769 excess cost of hospitalization ($25,112 vs $23,343; = .04).
ICE-guided LAAC is safer than TEE-guided LAAC, with similar rates of major complications. However, ICE use was associated with lower rates of gastrointestinal bleeding and higher rates of retroperitoneal bleeding. In addition, ICE-guided LAAC is associated with a similar length of stay but higher costs of hospitalization.
左心耳封堵术（LAAC）通常在经食管超声心动图（TEE）引导下进行。来自美国真实人群的关于心腔内超声心动图（ICE）引导下LAAC安全性的数据仍然有限。在本研究中，目的是使用美国国家住院样本评估ICE引导下LAAC手术的趋势和结果。
本研究使用了2015年第4季度至2019年的国家住院样本数据库。我们使用倾向匹配分析并对住院结局/并发症调整比值比。P值<.05被认为具有统计学意义。
我们识别出61,995例加权LAAC病例。其中，1410例患者接受了ICE引导下的LAAC，其年龄中位数低于接受TEE引导下LAAC的患者（75岁对77岁；P≤.01）。ICE引导下LAAC的使用从2015年的1.7%增加到2019年的2.2%（P =.75）。经调整分析，ICE引导和TEE引导的LAAC在主要、心血管、神经和肺部并发症方面相似。在倾向匹配分析中，总体血管并发症发生率相似。然而，ICE组的腹膜后出血仍然显著更高（0.7%对0%）。TEE引导下的LAAC中胃肠道出血并发症更频繁（3.5%对2.1%）。两组的住院时间相似（中位数 = 1天；P =.23）；然而，ICE与住院费用多出1769美元相关（25,112美元对23,343美元；P =.04）。
ICE引导下的LAAC比TEE引导下的LAAC更安全，主要并发症发生率相似。然而，使用ICE与较低的胃肠道出血率和较高的腹膜后出血率相关。此外，ICE引导下的LAAC与住院时间相似但住院费用更高相关。
