title: Comparison of Efficacy and Safety of Left Atrial Appendage Occlusion in Patients Aged <75 to ≥ 75 Years.
abstract: Left atrial appendage occlusion (LAAO) is emerging as a promising alternative to oral anticoagulation. Because aged patients present a greater risk of not only cardioembolic events but also major bleeding, LAAO might represent a valid alternative as this would allow oral anticoagulation cessation while keeping cardioembolic protection. The objective of the study was to explore the safety and efficacy of LAAO in elderly patients. Data from the AMPLATZER Cardiac Plug multicenter registry were analyzed. The cohort was categorized in 2 groups (<75 vs ≥ 75 years). A total of 1,053 subjects were included in the registry. Of them, 219 were excluded because of combined procedures. As a result, 828 subjects were included (54.6% ≥ 75 years). Procedural success was high and similar in both groups (97.3%). Acute procedural major adverse events were not statistically different among groups (3.2% in <75 years vs 5.1%; p = 0.17) although stratified analysis showed a higher incidence of cardiac tamponade in elderly patients (0.5% vs 2.2%; p = 0.04). With a median follow-up of 16.8 months, no significant differences in stroke/TIA (1.9% vs 2.3%; p = 0.89) and major bleeding (1.7% vs 2.6%; p = 0.54) were observed. In conclusion, LAAO was associated with similar procedural success in patients aged <75 and ≥ 75 years although older patients had a higher incidence of cardiac tamponade. At follow-up, stroke and major bleeding rates were similar among groups.
authors.affiliation: Department of Cardiology, Hospital Clinic of Barcelona, University of Barcelona, Spain. Electronic address: xavierfreixa@hotmail.com.
authors.forename: Xavier
authors.initials: X
authors.lastname: Freixa
authors.affiliation: CardioVascular Center Frankfurt, Frankfurt, Germany; Heart & Vascular Institute, Swedish Medical Center, Seattle, Washington.
authors.forename: Sameer
authors.initials: S
authors.lastname: Gafoor
authors.affiliation: Department of Cardiology, Hospital Clinic of Barcelona, University of Barcelona, Spain.
authors.forename: Ander
authors.initials: A
authors.lastname: Regueiro
authors.affiliation: Department of Cardiology, University Hospital of Salamanca, Salamanca, Spain.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Cruz-Gonzalez
authors.affiliation: Department of Cardiology, University Hospital of Bern, Bern, Switzerland.
authors.forename: Samera
authors.initials: S
authors.lastname: Shakir
authors.affiliation: Department of Cardiology, University Hospital of Bonn, Bonn, Germany.
authors.forename: Heyder
authors.initials: H
authors.lastname: Omran
authors.affiliation: Division of Cardiology, Fondazione Toscana Gabriele Monasterio, Massa, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Berti
authors.affiliation: Division of Cardiology, Ospedale Careggi di Firenze, Florence, Italy.
authors.forename: Gennaro
authors.initials: G
authors.lastname: Santoro
authors.affiliation: Division of Cardiology, Cliniques Universitaires Saint-Luc, University of Louvain, Brussels, Belgium.
authors.forename: Joelle
authors.initials: J
authors.lastname: Kefer
authors.affiliation: Department of Cardiology, Charite Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Ulf
authors.initials: U
authors.lastname: Landmesser
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Skejby, Denmark.
authors.forename: Jens Erik
authors.initials: JE
authors.lastname: Nielsen-Kudsk
authors.affiliation: CardioVascular Center Frankfurt, Frankfurt, Germany.
authors.forename: Horst
authors.initials: H
authors.lastname: Sievert
authors.affiliation: Department of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom.
authors.forename: Prapa
authors.initials: P
authors.lastname: Kanagaratnam
authors.affiliation: Department of Cardiology, Department of Cardiology, Cardiology University Heart Center, Zurich, Switzerland.
authors.forename: Fabian
authors.initials: F
authors.lastname: Nietlispach
authors.affiliation: Department of Cardiology, University Hospital of Bern, Bern, Switzerland.
authors.forename: Steffen
authors.initials: S
authors.lastname: Gloekler
authors.affiliation: Department of Cardiology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium.
authors.forename: Adel
authors.initials: A
authors.lastname: Aminian
authors.affiliation: Division of Cardiology, Ospedale Luigi Sacco, Milan, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Danna
authors.affiliation: Division of Cardiology, Fondazione Toscana Gabriele Monasterio, Massa, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Rezzaghi
authors.affiliation: Department of Cardiology, University Hospital of Bonn, Bonn, Germany.
authors.forename: Friederike
authors.initials: F
authors.lastname: Stock
authors.affiliation: Division of Cardiology, Ospedale Careggi di Firenze, Florence, Italy.
authors.forename: Miroslava
authors.initials: M
authors.lastname: Stolcova
authors.affiliation: Department of Cardiology, Coimbra's Hospital Center, Coimbra, Portugal.
authors.forename: Marco
authors.initials: M
authors.lastname: Costa
authors.affiliation: Montreal Heart Institute, Montreal, Canada.
authors.forename: Reda
authors.initials: R
authors.lastname: Ibrahim
authors.affiliation: Department of Cardiology, Universitätsmedizin Göttingen, Göttingen, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Schillinger
authors.affiliation: Department of Cardiology, Asklepios Hospital Hamburg, Hamburg, Germany.
authors.forename: Jai-Wun
authors.initials: JW
authors.lastname: Park
authors.affiliation: Department of Cardiology, University Hospital of Bern, Bern, Switzerland.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Meier
authors.affiliation: Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece.
authors.forename: Apostolos
authors.initials: A
authors.lastname: Tzikas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020517:Atrial Appendage; D001281:Atrial Fibrillation / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D006328:Cardiac Catheterization / Q000379:methods*; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012449:Safety; D055989:Septal Occluder Device; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome