Anesthetic Choice for Percutaneous Transcatheter Closure of the Left Atrial Appendage: A National Anesthesia Clinical Outcomes Registry Analysis.
Ann Card Anaesth
; 27(3): 220-227, 2024 Jul 01.
Article
in En
| MEDLINE
| ID: mdl-38963356
ABSTRACT
CONTEXT Left atrial appendage closure (LAAC) was developed as a novel stroke prevention alternative for patients with atrial fibrillation, particularly for those not suitable for long-term oral anticoagulant therapy. Traditionally, general anesthesia (GA) has been more commonly used primarily due to the necessity of transesophageal echocardiography. AIMS:
Compare trends of monitored anesthesia care (MAC) versus GA for percutaneous transcatheter LAAC with endocardial implant and assess for independent variables associated with primary anesthetic choice. SETTINGS ANDDESIGN:
Multi-institutional data collected from across the United States using the National Anesthesia Clinical Outcomes Registry. MATERIAL ANDMETHODS:
Retrospective data analysis from 2017-2021. STATISTICAL ANALYSIS USED Independent-sample t tests or Mann-Whitney U tests were used for continuous variables and Chi-square tests or Fisher's exact test for categorical variables. Multivariate logistic regression was used to assess patient and hospital characteristics.RESULTS:
A total of 19,395 patients underwent the procedure, and 352 patients (1.8%) received MAC. MAC usage trended upward from 2017-2021 (P < 0.0001). MAC patients were more likely to have an American Society of Anesthesiologists (ASA) physical status of≥ 4 (33.6% vs 22.89%) and to have been treated at centers in the South (67.7% vs 44.2%), in rural locations (71% vs 39.5%), and with lower median annual percutaneous transcatheter LAAC volume (102 vs 153 procedures) (all P < 0.0001). In multivariate analysis, patients treated in the West had 85% lower odds of receiving MAC compared to those in the Northeast (AOR 0.15; 95% CI 0.03-0.80, P = 0.0261).CONCLUSIONS:
While GA is the most common anesthetic technique for percutaneous transcatheter closure of the left atrial appendage, a small, statistically significant increase in MAC occurred from 2017-2021. Anesthetic management for LAAC varies with geographic location.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Atrial Fibrillation
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Cardiac Catheterization
/
Registries
/
Atrial Appendage
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Anesthesia, General
Limits:
Aged
/
Aged80
/
Female
/
Humans
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Male
/
Middle aged
Country/Region as subject:
America do norte
Language:
En
Journal:
Ann Card Anaesth
Year:
2024
Document type:
Article
Affiliation country:
United States
Country of publication:
India