Abstract
Subacute or late complications > 24 hours after left atrial appendage closure (LAAC)
are infrequent. We therefore created a clinical pathway to enable safe same-day discharge
(SDD) after LAAC. Patients were assessed for overall physical conditioning, lack of
significant frailty and comorbidities limiting physical abilities, good home support,
and patient preference. Of 78 LAACs performed, 24 patients (30.8%) were discharged
the same day: 21 were transesophageal echocardiography guided and 3 intracardiac echocardiography
guided. SDD clinical pathway patients were discharged 395.4 ± 56.6 minutes after leaving
the procedural room. There were no clinical complications at 1 month or in long-term
follow-up. SDD is safe and feasible after LAAC, following a dedicated clinical pathway
and surveillance in carefully selected patients.
Résumé
Les complications subaiguës et tardives > 24 heures après la fermeture de l’appendice
auriculaire gauche (FAAG) ne sont pas fréquentes. Par conséquent, nous avons élaboré
un cheminement clinique qui permet la sortie le jour même (SJM) en sûreté après la
FAAG. L’évaluation des patients a porté sur leur état physique global, l’absence de
fragilité et de comorbidités significatives qui limitent les capacités physiques,
leur maintien à domicile et leurs préférences. Parmi les 78 patients ayant subi une
FAAG, 24 (30,8 %) patients, dont 21 sous échocardiographie transœsophagienne et 3
sous échocardiographie intracardiaque, sont sortis de l’hôpital le jour même. Les
patients dont le cheminement clinique menait à la SJM sont sortis 395,4 ± 56,6 minutes
après avoir quitté la salle d’intervention. On n’a noté aucune complication clinique
au suivi après 1 mois ou au suivi à long terme. La SJM après la FAAG est sûre et réalisable
à la suite du cheminement clinique et de la surveillance ciblés des patients rigoureusement
sélectionnés.
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References
- Implant success and safety of left atrial appendage closure with the WATCHMAN device: peri-procedural outcomes from the EWOLUTION registry.Eur Heart J. 2016; 3: 2465-2474
- Post-approval U.S. experience with left atrial appendage closure for stroke prevention in atrial fibrillation.J Am Coll Cardiol. 2017; 6: 253-261
- A global clinical measure of fitness and frailty in elderly people.CMAJ. 2005; 1: 489-495
- Percutaneous left atrial appendage closure: procedural techniques and outcomes.JACC Cardiovasc Interv. 2014; 7: 1205-1220
Article info
Publication history
Published online: February 11, 2020
Accepted:
February 5,
2020
Received:
January 19,
2020
Footnotes
See page 947 for disclosure information.
Identification
Copyright
© 2020 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
