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Clinical Outcomes of Percutaneous Left-Atrial Appendage Occlusion with Conscious Sedation without an Anesthesiologist on Site: Results from a Multicenter Study

Background and Objectives: Percutaneous left-atrial appendage (LAA) occlusion is an important therapeutic option for preventing cardioembolic stroke in patients with non-valvular atrial fibrillation (AF) at high risk of thromboembolic events and with contraindications for oral anticoagulation (OAC)....

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Autores principales: Bianco, Matteo, Visalli, Andrea Carmelo, Tomassini, Francesco, Biolè, Carloalberto, Giacobbe, Federico, Rolfo, Cristina, Cerrato, Enrico, Franzè, Alfonso, Zanda, Greca, Pavani, Marco, Mousavi, Amir Hassan, Gobello, Giulia, Piedimonte, Giulio, Destefanis, Paola, Lazzero, Maurizio, Palacio Restrepo, Sara, Celentani, Dario, Luciano, Alessia, Tizzani, Emanuele, Chinaglia, Alessandra, Varbella, Ferdinando
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10673315/
https://www.ncbi.nlm.nih.gov/pubmed/38004090
http://dx.doi.org/10.3390/medicina59112041
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author Bianco, Matteo
Visalli, Andrea Carmelo
Tomassini, Francesco
Biolè, Carloalberto
Giacobbe, Federico
Rolfo, Cristina
Cerrato, Enrico
Franzè, Alfonso
Zanda, Greca
Pavani, Marco
Mousavi, Amir Hassan
Gobello, Giulia
Piedimonte, Giulio
Destefanis, Paola
Lazzero, Maurizio
Palacio Restrepo, Sara
Celentani, Dario
Luciano, Alessia
Tizzani, Emanuele
Chinaglia, Alessandra
Varbella, Ferdinando
author_facet Bianco, Matteo
Visalli, Andrea Carmelo
Tomassini, Francesco
Biolè, Carloalberto
Giacobbe, Federico
Rolfo, Cristina
Cerrato, Enrico
Franzè, Alfonso
Zanda, Greca
Pavani, Marco
Mousavi, Amir Hassan
Gobello, Giulia
Piedimonte, Giulio
Destefanis, Paola
Lazzero, Maurizio
Palacio Restrepo, Sara
Celentani, Dario
Luciano, Alessia
Tizzani, Emanuele
Chinaglia, Alessandra
Varbella, Ferdinando
author_sort Bianco, Matteo
collection PubMed
description Background and Objectives: Percutaneous left-atrial appendage (LAA) occlusion is an important therapeutic option for preventing cardioembolic stroke in patients with non-valvular atrial fibrillation (AF) at high risk of thromboembolic events and with contraindications for oral anticoagulation (OAC). It is usually performed with transesophageal echocardiography (TOE) guidance under general anesthesia (GA). In this retrospective study, we present a multicenter experience of LAA occlusion performed with conscious sedation (CS) without an anesthesiologist on site. Materials and Methods: All the patients on the waiting list for LAA occlusion procedure at Infermi Hospital, Rivoli, and San Luigi Gonzaga University Hospital, Orbassano, from October 2018 to October 2022 were analyzed. All the procedures were performed with a Watchman/FLX LAA closure device under TOE and fluoroscopic guidance without an anesthesiologist on site. CS was performed with a combination of midazolam and fentanyl as needed. Results: One-hundred fifteen patients were included (age 76.4 ± 7.6 years, median CHA2DS2Vasc 4.4 ± 1.4). CS was performed using midazolam (mean dose 5.9 ± 2.1 mg), adding fentanyl for thirty-nine (33.9%) patients in case of poor tolerance for the procedure despite midazolam. The acute procedural success rate was 99.1%. We observed seven acute severe complications. No patients needed anesthesiological assistance during the procedure, and no cases of respiratory failure necessitating ventilation were reported. In a follow-up after 10 ± 9 months, one case of stroke (0.9%) and one case (0.9%) of transient ischemic attack (TIA) occurred. Conclusions: LAA occlusion performed under CS and without the presence of an anesthesiologist on site appears to be safe and effective. It can be an attractive alternative to general anesthesia (GA), as fewer resources are required.
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spelling pubmed-106733152023-11-20 Clinical Outcomes of Percutaneous Left-Atrial Appendage Occlusion with Conscious Sedation without an Anesthesiologist on Site: Results from a Multicenter Study Bianco, Matteo Visalli, Andrea Carmelo Tomassini, Francesco Biolè, Carloalberto Giacobbe, Federico Rolfo, Cristina Cerrato, Enrico Franzè, Alfonso Zanda, Greca Pavani, Marco Mousavi, Amir Hassan Gobello, Giulia Piedimonte, Giulio Destefanis, Paola Lazzero, Maurizio Palacio Restrepo, Sara Celentani, Dario Luciano, Alessia Tizzani, Emanuele Chinaglia, Alessandra Varbella, Ferdinando Medicina (Kaunas) Article Background and Objectives: Percutaneous left-atrial appendage (LAA) occlusion is an important therapeutic option for preventing cardioembolic stroke in patients with non-valvular atrial fibrillation (AF) at high risk of thromboembolic events and with contraindications for oral anticoagulation (OAC). It is usually performed with transesophageal echocardiography (TOE) guidance under general anesthesia (GA). In this retrospective study, we present a multicenter experience of LAA occlusion performed with conscious sedation (CS) without an anesthesiologist on site. Materials and Methods: All the patients on the waiting list for LAA occlusion procedure at Infermi Hospital, Rivoli, and San Luigi Gonzaga University Hospital, Orbassano, from October 2018 to October 2022 were analyzed. All the procedures were performed with a Watchman/FLX LAA closure device under TOE and fluoroscopic guidance without an anesthesiologist on site. CS was performed with a combination of midazolam and fentanyl as needed. Results: One-hundred fifteen patients were included (age 76.4 ± 7.6 years, median CHA2DS2Vasc 4.4 ± 1.4). CS was performed using midazolam (mean dose 5.9 ± 2.1 mg), adding fentanyl for thirty-nine (33.9%) patients in case of poor tolerance for the procedure despite midazolam. The acute procedural success rate was 99.1%. We observed seven acute severe complications. No patients needed anesthesiological assistance during the procedure, and no cases of respiratory failure necessitating ventilation were reported. In a follow-up after 10 ± 9 months, one case of stroke (0.9%) and one case (0.9%) of transient ischemic attack (TIA) occurred. Conclusions: LAA occlusion performed under CS and without the presence of an anesthesiologist on site appears to be safe and effective. It can be an attractive alternative to general anesthesia (GA), as fewer resources are required. MDPI 2023-11-20 /pmc/articles/PMC10673315/ /pubmed/38004090 http://dx.doi.org/10.3390/medicina59112041 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Bianco, Matteo
Visalli, Andrea Carmelo
Tomassini, Francesco
Biolè, Carloalberto
Giacobbe, Federico
Rolfo, Cristina
Cerrato, Enrico
Franzè, Alfonso
Zanda, Greca
Pavani, Marco
Mousavi, Amir Hassan
Gobello, Giulia
Piedimonte, Giulio
Destefanis, Paola
Lazzero, Maurizio
Palacio Restrepo, Sara
Celentani, Dario
Luciano, Alessia
Tizzani, Emanuele
Chinaglia, Alessandra
Varbella, Ferdinando
Clinical Outcomes of Percutaneous Left-Atrial Appendage Occlusion with Conscious Sedation without an Anesthesiologist on Site: Results from a Multicenter Study
title Clinical Outcomes of Percutaneous Left-Atrial Appendage Occlusion with Conscious Sedation without an Anesthesiologist on Site: Results from a Multicenter Study
title_full Clinical Outcomes of Percutaneous Left-Atrial Appendage Occlusion with Conscious Sedation without an Anesthesiologist on Site: Results from a Multicenter Study
title_fullStr Clinical Outcomes of Percutaneous Left-Atrial Appendage Occlusion with Conscious Sedation without an Anesthesiologist on Site: Results from a Multicenter Study
title_full_unstemmed Clinical Outcomes of Percutaneous Left-Atrial Appendage Occlusion with Conscious Sedation without an Anesthesiologist on Site: Results from a Multicenter Study
title_short Clinical Outcomes of Percutaneous Left-Atrial Appendage Occlusion with Conscious Sedation without an Anesthesiologist on Site: Results from a Multicenter Study
title_sort clinical outcomes of percutaneous left-atrial appendage occlusion with conscious sedation without an anesthesiologist on site: results from a multicenter study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10673315/
https://www.ncbi.nlm.nih.gov/pubmed/38004090
http://dx.doi.org/10.3390/medicina59112041
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