Left Atrial Appendage Closure for Atrial Fibrillation in the Elderly >75 Years Old: A Meta-Analysis of Observational Studies
Background: Left atrial appendage closure (LAAC) is an established therapy for patients with atrial fibrillation (AF); however, there is a limited understanding of LAAC in elderly patients (≥75 years old). We conducted a meta-analysis to investigate the procedural complications and long-term outcome...
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MDPI AG
2022-12-01
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| Series: | Diagnostics |
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| Online Access: | https://www.mdpi.com/2075-4418/12/12/3174 |
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| author | Shaojie Han Ruikun Jia Shenyu Zhao Juan Chan Yixuan Bai Kaijun Cui |
| author_facet | Shaojie Han Ruikun Jia Shenyu Zhao Juan Chan Yixuan Bai Kaijun Cui |
| author_sort | Shaojie Han |
| collection | DOAJ |
| description | Background: Left atrial appendage closure (LAAC) is an established therapy for patients with atrial fibrillation (AF); however, there is a limited understanding of LAAC in elderly patients (≥75 years old). We conducted a meta-analysis to investigate the procedural complications and long-term outcomes after LAAC in the elderly versus the non-elderly. Methods: We screened PubMed, EMBASE, Cochrane Library, and Web of Science. Procedural endpoints of interest included successful implantation LAAC rates, in-hospital mortality, major bleeding events, pericardial effusion/tamponade, stroke, and vascular access complications related to LAAC. Long-term outcomes included all-cause mortality, major bleeding events, and stroke/transient ischemic attack (TIA) during follow-up. Results: Finally, 12 studies were included in the analysis; these included a total of 25,094 people in the elderly group and 36,035 people in the non-elderly group. The successful implantation LAAC rates did not differ between the groups, while the elderly patients experienced more periprocedural mortality (OR 2.62; 95% CI 1.79–3.83, <i>p</i> < 0.01; I<sup>2</sup> = 0%), pericardial effusion/tamponade (OR 1.39; 95% CI: 1.06–1.82, <i>p</i> < 0.01; I<sup>2</sup> = 0%), major bleeding events (OR 1.32; 95% CI 1.17–1.48, <i>p</i> < 0.01; I<sup>2</sup> = 0%), and vascular access complications (OR 1.34; 95% CI 1.16–1.55, <i>p</i> < 0.01; I<sup>2</sup> = 0%) than the non-elderly patients. The long-term stroke/TIA rates did not differ between the elderly and the non-elderly at least one year after follow-up. Conclusions: Even though successful implantation LAAC rates are similar, elderly patients have a significantly higher incidence of periprocedural mortality, major bleeding events, vascular access complications, and pericardial effusion/tamponade after LAAC than non-elderly patients. The stroke/TIA rates did not differ between both groups after at least one-year follow-up. |
| first_indexed | 2024-03-09T17:08:34Z |
| format | Article |
| id | doaj.art-a555c1c6588442f0aa65085753046a78 |
| institution | Directory Open Access Journal |
| issn | 2075-4418 |
| language | English |
| last_indexed | 2024-03-09T17:08:34Z |
| publishDate | 2022-12-01 |
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| series | Diagnostics |
| spelling | doaj.art-a555c1c6588442f0aa65085753046a782023-11-24T14:19:59ZengMDPI AGDiagnostics2075-44182022-12-011212317410.3390/diagnostics12123174Left Atrial Appendage Closure for Atrial Fibrillation in the Elderly >75 Years Old: A Meta-Analysis of Observational StudiesShaojie Han0Ruikun Jia1Shenyu Zhao2Juan Chan3Yixuan Bai4Kaijun Cui5Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, ChinaDepartment of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, ChinaDepartment of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, ChinaDepartment of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, ChinaDepartment of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, ChinaDepartment of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, ChinaBackground: Left atrial appendage closure (LAAC) is an established therapy for patients with atrial fibrillation (AF); however, there is a limited understanding of LAAC in elderly patients (≥75 years old). We conducted a meta-analysis to investigate the procedural complications and long-term outcomes after LAAC in the elderly versus the non-elderly. Methods: We screened PubMed, EMBASE, Cochrane Library, and Web of Science. Procedural endpoints of interest included successful implantation LAAC rates, in-hospital mortality, major bleeding events, pericardial effusion/tamponade, stroke, and vascular access complications related to LAAC. Long-term outcomes included all-cause mortality, major bleeding events, and stroke/transient ischemic attack (TIA) during follow-up. Results: Finally, 12 studies were included in the analysis; these included a total of 25,094 people in the elderly group and 36,035 people in the non-elderly group. The successful implantation LAAC rates did not differ between the groups, while the elderly patients experienced more periprocedural mortality (OR 2.62; 95% CI 1.79–3.83, <i>p</i> < 0.01; I<sup>2</sup> = 0%), pericardial effusion/tamponade (OR 1.39; 95% CI: 1.06–1.82, <i>p</i> < 0.01; I<sup>2</sup> = 0%), major bleeding events (OR 1.32; 95% CI 1.17–1.48, <i>p</i> < 0.01; I<sup>2</sup> = 0%), and vascular access complications (OR 1.34; 95% CI 1.16–1.55, <i>p</i> < 0.01; I<sup>2</sup> = 0%) than the non-elderly patients. The long-term stroke/TIA rates did not differ between the elderly and the non-elderly at least one year after follow-up. Conclusions: Even though successful implantation LAAC rates are similar, elderly patients have a significantly higher incidence of periprocedural mortality, major bleeding events, vascular access complications, and pericardial effusion/tamponade after LAAC than non-elderly patients. The stroke/TIA rates did not differ between both groups after at least one-year follow-up.https://www.mdpi.com/2075-4418/12/12/3174atrial fibrillationleft atrial appendage closuremeta-analysiselderlycomplication |
| spellingShingle | Shaojie Han Ruikun Jia Shenyu Zhao Juan Chan Yixuan Bai Kaijun Cui Left Atrial Appendage Closure for Atrial Fibrillation in the Elderly >75 Years Old: A Meta-Analysis of Observational Studies Diagnostics atrial fibrillation left atrial appendage closure meta-analysis elderly complication |
| title | Left Atrial Appendage Closure for Atrial Fibrillation in the Elderly >75 Years Old: A Meta-Analysis of Observational Studies |
| title_full | Left Atrial Appendage Closure for Atrial Fibrillation in the Elderly >75 Years Old: A Meta-Analysis of Observational Studies |
| title_fullStr | Left Atrial Appendage Closure for Atrial Fibrillation in the Elderly >75 Years Old: A Meta-Analysis of Observational Studies |
| title_full_unstemmed | Left Atrial Appendage Closure for Atrial Fibrillation in the Elderly >75 Years Old: A Meta-Analysis of Observational Studies |
| title_short | Left Atrial Appendage Closure for Atrial Fibrillation in the Elderly >75 Years Old: A Meta-Analysis of Observational Studies |
| title_sort | left atrial appendage closure for atrial fibrillation in the elderly 75 years old a meta analysis of observational studies |
| topic | atrial fibrillation left atrial appendage closure meta-analysis elderly complication |
| url | https://www.mdpi.com/2075-4418/12/12/3174 |
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