Feasibility and Safety of Intracardiac Echocardiography Use in Transcatheter Left Atrial Appendage Closure Procedures
Department
Medicine
Document Type
Article
Publication Title
Journal of the Society for Cardiovascular Angiography & Interventions
Abstract
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.
First Page
100510
DOI
10.1016/j.jscai.2022.100510
Volume
1
Issue
6
Publication Date
11-2022
Recommended Citation
Zahid, S., Gowda, S., Hashem, A., & Rai, D. (2022). Feasibility and Safety of Intracardiac Echocardiography Use in Transcatheter Left Atrial Appendage Closure Procedures. Journal of the Society for Cardiovascular Angiography & Interventions, 1 (6), 100510. https://doi.org/10.1016/j.jscai.2022.100510
Comments
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