TY - JOUR
T1 - Feasibility and Safety of Intracardiac Echocardiography Use in Transcatheter Left Atrial Appendage Closure Procedures
AU - Zahid, Salman
AU - Gowda, Smitha
AU - Hashem, Anas
AU - Khan, Muhammad Zia
AU - Ullah, Waqas
AU - Kaur, Gurleen
AU - Nasir, Usama
AU - Rai, Devesh
AU - Faza, Nadeen N.
AU - Little, Stephen H.
AU - Valderrabano, Miguel
AU - Goel, Sachin S.
N1 - Funding Information:
Dr Goel is a consultant for Medtronic and a member of the speakers bureau for Abbott Structural Heart. Drs Zahid, Gowda, Hashem, Khan, Ullah, Kaur, Nasir, Rai, Faza, Little, and Valderrabano reported no financial interests. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Institutional review board approval and informed consent were not required for this study because National Inpatient Sample data are deidentified and publicly available.
Publisher Copyright:
© 2022 The Author(s)
PY - 2022/11/1
Y1 - 2022/11/1
N2 - Background: 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. Methods: 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 P value of <.05 was considered significant. Results: 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; P ≤.01). The use of ICE-guided LAAC increased from 1.7% in 2015 to 2.2% in 2019 (Ptrend =.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; P =.23); however, ICE was associated with $1769 excess cost of hospitalization ($25,112 vs $23,343; P =.04). Conclusions: 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.
AB - Background: 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. Methods: 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 P value of <.05 was considered significant. Results: 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; P ≤.01). The use of ICE-guided LAAC increased from 1.7% in 2015 to 2.2% in 2019 (Ptrend =.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; P =.23); however, ICE was associated with $1769 excess cost of hospitalization ($25,112 vs $23,343; P =.04). Conclusions: 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.
KW - echocardiography
KW - intracardiac echocardiography
KW - left atrial appendage closure
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U2 - 10.1016/j.jscai.2022.100510
DO - 10.1016/j.jscai.2022.100510
M3 - Article
AN - SCOPUS:85147214985
SN - 2772-9303
VL - 1
JO - Journal of the Society for Cardiovascular Angiography and Interventions
JF - Journal of the Society for Cardiovascular Angiography and Interventions
IS - 6
M1 - 100510
ER -