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Canadian Journal of Cardiology

Safety and Feasibility of Same-Day Discharge After Left Atrial Appendage Closure

Published:February 11, 2020DOI:https://doi.org/10.1016/j.cjca.2020.02.069

      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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