Gender Specified In-Hospital Outcome after Left Atrial Appendage Closure with a Dual Occlusive Mechanism Device
Main Article Content
Abstract
Background: Recent studies have suggested an increased rate of adverse events in women following left atrial appendage occlusion (LAAO), particularly with dual occlusive mechanism devices.
Objectives: This study aimed to investigate gender disparities in in-hospital adverse events and short-term device-related outcomes in an experienced center using dual occlusive mechanism devices exclusively.
Methods: In a single-center retrospective study, patients who received dual occlusive mechanism devices (Amplatzer cardiac plug and Amulet) were analyzed. We assessed gender differences in patient characteristics, LAAO indications, procedural data, in-hospital complications, and short-term device-related outcomes in the form of one-month follow-up transesophageal echocardiography.
Results: Among 474 patients, 211 (45%) were women. At device implantation, women were significantly older (77.45±6.98 years vs. 75.89±7.26; p = 0.01), with higher CHA2DS2Vasc scores (5.03±1.46 vs. 4.28±1.51; p < 0.01) and lower HASBLED scores (3.78±1.06 vs. 4.03±1.12; p = 0.01) compared to men. Men had a higher prevalence of coronary artery disease (52% vs. 32%; p < 0.01). LAAO indications did not significantly differ. Device success was 99% in men and 98% in women (p = 0.75). In-hospital complications, including deaths, major bleedings, and pericardial effusion, did not significantly vary by gender. Rates of device-related thrombus and device closure with a residual jet ≤ 5 mm were similar.
Conclusions: In a large cohort of consecutive LAAO patients at an experienced center, gender was not linked to higher in-hospital complications.
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
I. Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C et al.; ESC Scientific Document Group. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J. 2021 Feb 1;42(5):373-498.
II. Jiang H, Koh TH, Vengkat V, Fei G, Ding ZP, Ewe SH et al. An Updated Meta-Analysis on the Clinical Outcomes of Percutaneous Left Atrial Appendage Closure Versus Direct Oral Anticoagulation in Patients With Atrial Fibrillation. Am J Cardiol. 2023 Aug 1;200:135-143.
III. Sievert K, Asmarats L, Arzamendi D. Left Atrial Appendage Occlusion Strengths and Weaknesses of the Lobe-Only Occluder Concept in Theory and in Practice. Card Electrophysiol Clin. 2023 Jun;15(2):193-200.
IV. Wong I, Tzikas A, Søndergaard L, De Backer O. The Strengths and Weaknesses of the LAA Covering Disc Occluders-Conceptually and in Practice. Card Electrophysiol Clin. 2023 Jun;15(2):183-192.
V. Alfadhel M, Nestelberger T, Samuel R, McAlister C, Saw J. Left atrial appendage closure - Current status and future directions. Prog Cardiovasc Dis. 2021 Nov-Dec;69:101-109.
VI. Mathai SV, Sohal S, Flatow E, Nagaraj S, Hajra A, Chugh Yet al. Sex Differences in Periprocedural and Long-Term Outcomes Following Transcatheter Left Atrial Appendage Occlusion: A Systematic Review and Meta-Analysis. Cardiovasc Revasc Med. 2023 Mar;48:23-31.
VII. Alkhouli M, Russo AM, Thaler D, Windecker S, Anderson JA, Gage R et al. Sex Differences in Safety and Effectiveness of LAAO: Insights From the Amulet IDE Trial. JACC Cardiovasc Interv. 2022 Nov 14;15(21):2143-2155.
VIII. De Caterina AR, Nielsen-Kudsk JE, Schmidt B, Mazzone P, Fischer S, Lund J et al. Gender difference in left atrial appendage occlusion outcomes: Results from the Amplatzer™ Amulet™ Observational Study. Int J Cardiol Heart Vasc. 2021 Jul 26;35:100848.
IX. Osman M, Patel B, Munir MB, Kawsara A, Kheiri B, Balla S et al. Sex-stratified analysis of the safety of percutaneous left atrial appendage occlusion. Catheter Cardiovasc Interv. 2021 Apr 1;97(5):885-892.
X. Kleinecke C, Lewalter T, Sievert H, Geist V, Zeymer U, Mudra H et al. Interventional occlusion of left atrial appendage in patients with atrial fibrillation. Gender-related outcomes in the German LAARGE Registry. J Cardiovasc Electrophysiol. 2021 Oct;32(10):2636-2644.
XI. Darden D, Duong T, Du C, Munir MB, Han FT, Reeves R et al. Sex Differences in Procedural Outcomes Among Patients Undergoing Left Atrial Appendage Occlusion: Insights From the NCDR LAAO Registry. JAMA Cardiol. 2021 Nov 1;6(11):1275-1284.
XII. Lakkireddy D, Thaler D, Ellis CR, Swarup V, Sondergaard L, Carroll J et al. Amplatzer Amulet Left Atrial Appendage Occluder Versus Watchman Device for Stroke Prophylaxis (Amulet IDE): A Randomized, Controlled Trial. Circulation. 2021 Nov 9;144(19):1543-1552.
XIII. Plášek J, Wichterle D, Peichl P, Čihák R, Jarkovský P, Roubíček T et al. Gender differences in major vascular complications of catheter ablation for atrial fibrillation. J Cardiovasc Electrophysiol. 2021 Mar;32(3):647-656.
XIV. Hana D, Miller T, Chaker Z, Chobufo MD, Khan A, Patel B et al. Evaluating Gender-based Differences in Clinical Outcomes for Patients Undergoing Left Atrial Appendage Occlusion: A Single Centre Experience. Curr Probl Cardiol. 2023 Mar;48(3):101532.