Short‐Term Outcomes Following Left Atrial Appendage Closure in the Very Elderly: A Population‐Based Analysis

BACKGROUND: Data on percutaneous left atrial appendage closure (LAAC) outcomes in the very elderly with atrial fibrillation are limited. We aimed to investigate the clinical characteristics and short‐term outcomes of patients 80 years or older following percutaneous LAAC in a large nationwide database. METHODS AND RESULTS: Using the Nationwide Readmissions Database, we identified patients who underwent percutaneous LAAC between January 2016 and December 2018. Patients were categorized based on age (≥80 and <80 years old). The primary outcome was in‐hospital mortality. Secondary outcomes were in‐hospital end points including periprocedural complications, 30‐day outcomes, and all‐cause 30‐day readmissions. A propensity score–matched model (1:1) was used to adjust for baseline characteristics among the study groups. A total of 13 208 patients were included in this study (43% women, median age in years [interquartile range] 79.5 [73–84]) and matched one‐to‐one (6604 and 6604 patients were ≥80 and <80 years old, respectively). In‐hospital mortality was not statistically different between the study groups and occurred in 21 patients ≥80 years old (0.32%) and in 14 patients <80 years old (0.21%); P=0.236. Rates of in‐hospital stroke/transient ischemic attack were higher in patients ≥80 years old compared with those <80 years old (1.22% versus 0.77%; P=0.009). In‐hospital bleeding requiring transfusion, vascular complications, systemic embolization, and pericardial effusion/tamponade requiring pericardiocentesis or surgical intervention occurred more frequently in patients ≥80 years old. Furthermore, the elderly group was more likely to be readmitted within 30 days compared with those <80 years old (9.91% versus 8.4%; P=0.004); however, rates of 30‐day complications were not statistically different between the study groups. CONCLUSIONS: In a large nationwide database, patients ≥80 years old undergoing percutaneous LAAC were found to have similar in‐hospital mortality but an increased risk of periprocedural complications and 30‐day readmission compared with younger patients. Our data suggest that LAAC should be considered on a case‐by‐case basis in the very elderly, taking into consideration the risks and benefits of this intervention. Further studies are needed to assess long‐term LAAC outcomes in this high‐risk population.