Joelle Kefer1, Apostolos Tzikas2, Xavier Freixa3, Samera Shakir4, Sameer Gafoor5, Jens Erik Nielsen-Kudsk6, Sergio Berti7, Gennaro Santoro8, Adel Aminian9, Ulf Landmesser10, Fabian Nietlispach11, Reda Ibrahim12, Paolo Luciano Danna13, Edouard Benit14, Werner Budts15, Francis Stammen16, Tom De Potter17, Tobias Tichelbäcker18, Steffen Gloekler4, Prapa Kanagaratnam19, Marco Costa20, Ignacio Cruz-Gonzalez21, Horst Sievert22, Wolfgang Schillinger18, Jai-Wun Park23, Bernhard Meier4, Heyder Omran24. 1. Cliniques universitaires Saint-Luc, Brussels, Belgium. Electronic address: joelle.kefer@uclouvain.be. 2. Interbalkan European Medical Center, Thessaloniki, Greece. 3. Hospital Clinic of University of Barcelona, Barcelona, Spain. 4. University Hospital of bern, Bern, Switzerland. 5. CardioVascular Center Frankfurt, Frankfurt, Germany; Seattle Heart and Vascular, Seattle, WA, USA. 6. Aarhus University Hospital, Skejby, Denmark. 7. Heart Hospital, Fondazione C.N.R. Regione Toscana, Massa, Italy. 8. Ospedale Careggi di Firenze, Florence, Italy. 9. Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium. 10. University Hospital of Zurich, Zurich, Switzerland. 11. University Hospital of bern, Bern, Switzerland; University Hospital of Zurich, Zurich, Switzerland. 12. Montreal Heart Institute, Montreal, Canada. 13. Ospedale Luigi Sacco, Milan, Italy. 14. Jessaziekenhuis, Hasselt, Belgium. 15. UZ Leuven, Leuven, Belgium. 16. AZ Delta Roeselare, Roeselare, Belgium. 17. OLV Ziekenhuis, Aalst, Belgium. 18. Universitätsmedizin Göttingen, Göttingen, Germany. 19. Imperial College Healthcare NHS Trust, London, United Kingdom. 20. Coimbra University Hospital Centre, Coimbra, Portugal. 21. University Hospital of Salamanca, Salamanca, Spain. 22. CardioVascular Center Frankfurt, Frankfurt, Germany. 23. Asklepios Hospital Hamburg, Hamburg, Germany. 24. University Hospital of Bonn, Bonn, Germany.
Abstract
BACKGROUND: Left atrial appendage occlusion (LAAO) using the Amplatzer cardiac plug (ACP) is a preventive treatment of atrial fibrillation related thromboembolism. AIM: To assess the safety and efficacy of LAAO in patients with chronic kidney disease (CKD). METHODS: Among the ACP multicentre registry, 1014 patients (75±8yrs) with available renal function were included. RESULTS: Patients with CKD (N=375, CHA2DS2-VASc: 4.9±1.5, HASBLED: 3.4±1.3) were at higher risk than patients without CKD (N=639, CHA2DS2-VASc: 4.2±1.6, HASBLED: 2.9±1.2; p<0.001 for both). Procedural (97%) and occlusion (99%) success were similarly high in all stages of CKD. Peri-procedural major adverse events (MAE) were observed in 5.1% of patients, 0.8% of death, with no difference between patients with and those without CKD (6.1 vs 4.5%, p=0.47). In patients with complete follow-up (1319 patients years), the annual stroke+transient ischaemic attack (TIA) rate was 2.3% and the observed bleeding rate was 2.1% (62 and 60% less than expected, similarly among patients with and those without CKD). Kaplan-Meier analysis showed a lower overall survival (84 vs 96% and 84 vs 93% at 1 and 2yrs. respectively; p<0.001) among patients with an eGFR <30ml/min/1.73m(2). CONCLUSION: LAAO using the ACP has a similar procedural safety among CKD patients compared to patients with normal renal function. LAAO with ACP offers a dramatic reduction of stroke+TIA rate and of bleeding rate persistent in all stages of CKD, as compared to the expected annual risk.
BACKGROUND:Left atrial appendage occlusion (LAAO) using the Amplatzer cardiac plug (ACP) is a preventive treatment of atrial fibrillation related thromboembolism. AIM: To assess the safety and efficacy of LAAO in patients with chronic kidney disease (CKD). METHODS: Among the ACP multicentre registry, 1014 patients (75±8yrs) with available renal function were included. RESULTS:Patients with CKD (N=375, CHA2DS2-VASc: 4.9±1.5, HASBLED: 3.4±1.3) were at higher risk than patients without CKD (N=639, CHA2DS2-VASc: 4.2±1.6, HASBLED: 2.9±1.2; p<0.001 for both). Procedural (97%) and occlusion (99%) success were similarly high in all stages of CKD. Peri-procedural major adverse events (MAE) were observed in 5.1% of patients, 0.8% of death, with no difference between patients with and those without CKD (6.1 vs 4.5%, p=0.47). In patients with complete follow-up (1319 patients years), the annual stroke+transient ischaemic attack (TIA) rate was 2.3% and the observed bleeding rate was 2.1% (62 and 60% less than expected, similarly among patients with and those without CKD). Kaplan-Meier analysis showed a lower overall survival (84 vs 96% and 84 vs 93% at 1 and 2yrs. respectively; p<0.001) among patients with an eGFR <30ml/min/1.73m(2). CONCLUSION: LAAO using the ACP has a similar procedural safety among CKD patients compared to patients with normal renal function. LAAO with ACP offers a dramatic reduction of stroke+TIA rate and of bleeding rate persistent in all stages of CKD, as compared to the expected annual risk.
Authors: G Schlieper; V Schwenger; A Remppis; T Keller; R Dechend; S Massberg; S Baldus; T Weinreich; G Hetzel; J Floege; F Mahfoud; D Fliser Journal: Internist (Berl) Date: 2017-05 Impact factor: 0.743
Authors: Alexander Sedaghat; Vivian Vij; Samuel R Streit; Jan Wilko Schrickel; Baravan Al-Kassou; Dominik Nelles; Caroline Kleinecke; Stephan Windecker; Bernhard Meier; Marco Valglimigli; Fabian Nietlispach; Georg Nickenig; Steffen Gloekler Journal: Clin Res Cardiol Date: 2019-07-05 Impact factor: 5.460