Quiroz Alfaro Alejandro José, Russell Noah E, Munshi Ruhul, Hassan Waleed, Stone James E, Abdelrahim Elsheikh M, Crossen Karl J, Prasad Karthik Venkatesh
Department of Internal Medicine, North Mississippi Medical Center, Tupelo, Mississippi.
Department of Electrophysiology, North Mississippi Medical Center, Tupelo, Mississippi.
Heart Rhythm O2. 2024 Oct 21;5(12):936-941. doi: 10.1016/j.hroo.2024.10.004. eCollection 2024 Dec.
Historically, percutaneous transcatheter left atrial appendage closure (LAAC) has been performed under general anesthesia (GA) with transesophageal echocardiographic images obtained by a noninvasive cardiologist and usually requires an overnight hospital stay. Alternatively, we present our single-center experience performing LAACs under deep sedation (DS), employing an echocardiographic technician instead of a noninvasive cardiologist, and expediting same-day discharge. Mid- to long-term outcomes were also evaluated with follow-up imaging at a 45-day visit.
The purpose of this study was to demonstrate the safety, feasibility, and outcomes of our single-operator-technician LAAC approach.
A total of 150 patients, with elevated CHADS-VASc scores (a mean of 4 points), underwent transesophageal echocardiography-guided LAAC using the WATCHMAN FLX (Boston Scientific, Marlborough, MA) device under DS.
The mean age of patients was 78 years. Seventy-six (51%) were men. One hundred forty-seven patients (98%) had the LAAC device successfully implanted, and 145 (97%) were discharged on the same day. Nine patients (6%) required conversion from DS to GA. Only 5 patients (4%) had complications during the procedure. None of the patients died or had complications from DS. During the 45-day follow-up visit, one patient had a significant peridevice leak (maximum diameter ≥ 5 mm) and another patient had device-related thrombosis.
Our novel single-operator-technician approach under DS is safe and feasible. Implementing protocols to simplify the traditional 2-operator approach under GA by using DS and an echocardiography technician as well as incorporating same-day discharge could make LAACs more widely available and potentially reduce procedural costs.
从历史上看，经皮经导管左心耳封堵术（LAAC）一直是在全身麻醉（GA）下进行的，由非侵入性心脏病专家获取经食管超声心动图图像，并且通常需要住院过夜。作为替代方案，我们介绍了我们在深度镇静（DS）下进行LAAC的单中心经验，使用超声心动图技术人员而非非侵入性心脏病专家，并加快当日出院。还在45天随访时通过后续成像评估了中长期结果。
本研究的目的是证明我们的单操作者-技术人员LAAC方法的安全性、可行性和结果。
共有150例CHADS-VASc评分升高（平均4分）的患者，在DS下使用WATCHMAN FLX（波士顿科学公司，马萨诸塞州马尔伯勒）装置接受经食管超声心动图引导的LAAC。
患者的平均年龄为78岁。76例（51%）为男性。147例患者（98%）成功植入了LAAC装置，145例（97%）在同一天出院。9例患者（6%）需要从DS转为GA。仅5例患者（4%）在手术过程中出现并发症。没有患者因DS死亡或出现并发症。在45天的随访中，1例患者出现严重的装置周围渗漏（最大直径≥5 mm），另1例患者出现与装置相关的血栓形成。
我们在DS下的新型单操作者-技术人员方法是安全可行的。通过使用DS和超声心动图技术人员实施简化传统GA下双操作者方法的方案，并纳入当日出院，可使LAAC更广泛地应用，并可能降低手术成本。
