Heart Team for Left Atrial Appendage Occlusion: A Patient-Tailored Approach
Background and Purpose: Left atrial appendage occlusion (LAAO) is an accepted therapeutic option for stroke prevention; however, the ideal technique and device have not yet been identified. In this study we evaluate the potential role of a heart team approach for patients contraindicated for oral an...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-12-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/11/1/176 |
| _version_ | 1797498587885600768 |
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| author | Stefano Branzoli Fabrizio Guarracini Massimiliano Marini Giovanni D’Onghia Daniele Penzo Silvio Piffer Dimitri Peterlana Angelo Graffigna Michele Massimo Gulizia Sandro Gelsomino Mark La Meir |
| author_facet | Stefano Branzoli Fabrizio Guarracini Massimiliano Marini Giovanni D’Onghia Daniele Penzo Silvio Piffer Dimitri Peterlana Angelo Graffigna Michele Massimo Gulizia Sandro Gelsomino Mark La Meir |
| author_sort | Stefano Branzoli |
| collection | DOAJ |
| description | Background and Purpose: Left atrial appendage occlusion (LAAO) is an accepted therapeutic option for stroke prevention; however, the ideal technique and device have not yet been identified. In this study we evaluate the potential role of a heart team approach for patients contraindicated for oral anticoagulants and indicated for left atrial appendage closure, to minimize risk and optimize benefit in a patient-centered decision-making process. Methods: Forty patients were evaluated by the heart team for appendage occlusion. Variables considered were CHA<sub>2</sub>DS<sub>2</sub>VASc, HASBLED, documented blood transfusions, comorbidities, event forcing anticoagulant interruption, past medical history, anatomy of the left atrial appendage, and patient quality of life. Twenty patients had their appendage occluded percutaneously (65% male, mean age 72.3 ± 7.5, mean CHA<sub>2</sub>DS<sub>2</sub>VASc 4.2 ± 1.5, mean HASBLED 3.5 ± 1.1). The other twenty underwent thoracoscopic occlusion (65% male, mean age of 74.9 ± 8, mean CHA<sub>2</sub>DS<sub>2</sub>VASc 6.0 ± 1.5, HASBLED mean 5.4 ± 1.4). Percutaneous patients were on dual antiplatelet therapy for the first three months and aspirin thereafter, whereas the others received no anticoagulant/antiplatelet therapy from the day of surgery. Follow up included TEE, CT scan, and periodical clinical evaluation. Results: Mean duration of procedures and hospital stay were comparable. All patients had complete exclusion of the appendage; at a mean follow up of 33.1 ± 14.1 months, no neurological or hemorrhagic events were reported. Conclusions: A heart team approach may improve the decision-making process for stroke and hemorrhage prevention, where LAAO is a therapeutic option. Percutaneous and thoracoscopic appendage occlusion seem to be comparably safe and effective. An epicardial LAAO could be advisable in patients for whom the risk of bleeding is estimated as being too high for post-procedural antiplatelet therapy. |
| first_indexed | 2024-03-10T03:35:29Z |
| format | Article |
| id | doaj.art-2e348cfce3344991a5635bc968b38a59 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T03:35:29Z |
| publishDate | 2021-12-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-2e348cfce3344991a5635bc968b38a592023-11-23T11:44:47ZengMDPI AGJournal of Clinical Medicine2077-03832021-12-0111117610.3390/jcm11010176Heart Team for Left Atrial Appendage Occlusion: A Patient-Tailored ApproachStefano Branzoli0Fabrizio Guarracini1Massimiliano Marini2Giovanni D’Onghia3Daniele Penzo4Silvio Piffer5Dimitri Peterlana6Angelo Graffigna7Michele Massimo Gulizia8Sandro Gelsomino9Mark La Meir10Department of Cardiac Surgery, UZ Brussel, Av. du Laerbeek 101, 1090 Brussels, BelgiumDepartment of Cardiology, Santa Chiara Hospital, Largo Medaglie d’oro, 38122 Trento, ItalyDepartment of Cardiology, Santa Chiara Hospital, Largo Medaglie d’oro, 38122 Trento, ItalyDepartment of Cardiology, Santa Chiara Hospital, Largo Medaglie d’oro, 38122 Trento, ItalyDepartment of Anesthesia, Santa Chiara Hospital, Largo Medaglie d’oro, 38122 Trento, ItalyNeurology Unit, Santa Chiara Hospital, Largo Medaglie d’oro, 38122 Trento, ItalyDivision of General Internal Medicine Santa Chiara Hospital, Largo Medaglie d’oro, 38122 Trento, ItalyCardiac Surgery Unit, Santa Chiara Hospital, Largo Medaglie d’oro, 38122 Trento, ItalyCardiology Complex Unit, Garibaldi Nesima Hospital, 95122 Catania, ItalyDepartment of Cardiac Surgery, UZ Brussel, Av. du Laerbeek 101, 1090 Brussels, BelgiumDepartment of Cardiac Surgery, UZ Brussel, Av. du Laerbeek 101, 1090 Brussels, BelgiumBackground and Purpose: Left atrial appendage occlusion (LAAO) is an accepted therapeutic option for stroke prevention; however, the ideal technique and device have not yet been identified. In this study we evaluate the potential role of a heart team approach for patients contraindicated for oral anticoagulants and indicated for left atrial appendage closure, to minimize risk and optimize benefit in a patient-centered decision-making process. Methods: Forty patients were evaluated by the heart team for appendage occlusion. Variables considered were CHA<sub>2</sub>DS<sub>2</sub>VASc, HASBLED, documented blood transfusions, comorbidities, event forcing anticoagulant interruption, past medical history, anatomy of the left atrial appendage, and patient quality of life. Twenty patients had their appendage occluded percutaneously (65% male, mean age 72.3 ± 7.5, mean CHA<sub>2</sub>DS<sub>2</sub>VASc 4.2 ± 1.5, mean HASBLED 3.5 ± 1.1). The other twenty underwent thoracoscopic occlusion (65% male, mean age of 74.9 ± 8, mean CHA<sub>2</sub>DS<sub>2</sub>VASc 6.0 ± 1.5, HASBLED mean 5.4 ± 1.4). Percutaneous patients were on dual antiplatelet therapy for the first three months and aspirin thereafter, whereas the others received no anticoagulant/antiplatelet therapy from the day of surgery. Follow up included TEE, CT scan, and periodical clinical evaluation. Results: Mean duration of procedures and hospital stay were comparable. All patients had complete exclusion of the appendage; at a mean follow up of 33.1 ± 14.1 months, no neurological or hemorrhagic events were reported. Conclusions: A heart team approach may improve the decision-making process for stroke and hemorrhage prevention, where LAAO is a therapeutic option. Percutaneous and thoracoscopic appendage occlusion seem to be comparably safe and effective. An epicardial LAAO could be advisable in patients for whom the risk of bleeding is estimated as being too high for post-procedural antiplatelet therapy.https://www.mdpi.com/2077-0383/11/1/176heart teamleft atrial appendage occlusioncontraindication oral anticoagulantspercutaneous procedurethoracoscopic surgery |
| spellingShingle | Stefano Branzoli Fabrizio Guarracini Massimiliano Marini Giovanni D’Onghia Daniele Penzo Silvio Piffer Dimitri Peterlana Angelo Graffigna Michele Massimo Gulizia Sandro Gelsomino Mark La Meir Heart Team for Left Atrial Appendage Occlusion: A Patient-Tailored Approach Journal of Clinical Medicine heart team left atrial appendage occlusion contraindication oral anticoagulants percutaneous procedure thoracoscopic surgery |
| title | Heart Team for Left Atrial Appendage Occlusion: A Patient-Tailored Approach |
| title_full | Heart Team for Left Atrial Appendage Occlusion: A Patient-Tailored Approach |
| title_fullStr | Heart Team for Left Atrial Appendage Occlusion: A Patient-Tailored Approach |
| title_full_unstemmed | Heart Team for Left Atrial Appendage Occlusion: A Patient-Tailored Approach |
| title_short | Heart Team for Left Atrial Appendage Occlusion: A Patient-Tailored Approach |
| title_sort | heart team for left atrial appendage occlusion a patient tailored approach |
| topic | heart team left atrial appendage occlusion contraindication oral anticoagulants percutaneous procedure thoracoscopic surgery |
| url | https://www.mdpi.com/2077-0383/11/1/176 |
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