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Left atrial appendage closure in end-stage renal disease and hemodialysis: data from a German multicenter registry

Background Left atrial appendage closure (LAAC) has emerged as an alternative to oral anticoagulation (OAC) for stroke prevention in patients with atrial fibrillation (AF). OAC treatment has been proven feasible in mild-to-moderate chronic kidney disease (CKD). In contrast, the optimal antithromboti...

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Main Authors: Fink, Thomas (Author) , Paitazoglou, Christina (Author) , Bergmann, Martin W. (Author) , Sano, Makoto (Author) , Keelani, Ahmad (Author) , Sciacca, Vanessa (Author) , Saad, Mohammed (Author) , Eitel, Charlotte (Author) , Heeger, Christian-Hendrik (Author) , Skurk, Carsten (Author) , Landmesser, Ulf (Author) , Thiele, Holger (Author) , Stiermaier, Thomas (Author) , Fuernau, Georg (Author) , Reil, Jan-Christian (Author) , Frey, Norbert (Author) , Kuck, Karl-Heinz (Author) , Tilz, Roland R. (Author) , Sandri, Marcus (Author) , Eitel, Ingo (Author)
Format: Article (Journal)
Language:English
Published: February 15, 2023
In: Catheterization and cardiovascular interventions
Year: 2023, Volume: 101, Issue: 3, Pages: 610-619
ISSN:1522-726X
DOI:10.1002/ccd.30559
Online Access:Verlag, kostenfrei, Volltext: https://doi.org/10.1002/ccd.30559
Verlag, kostenfrei, Volltext: https://onlinelibrary.wiley.com/doi/abs/10.1002/ccd.30559
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Author Notes:Thomas Fink, Christina Paitazoglou, Martin W. Bergmann, Makoto Sano, Ahmad Keelani, Vanessa Sciacca, Mohammed Saad, Charlotte Eitel, Christian-Hendrik Heeger, Carsten Skurk, Ulf Landmesser, Holger Thiele, Thomas Stiermaier, Georg Fuernau, Jan-Christian Reil, Norbert Frey, Karl-Heinz Kuck, Roland R. Tilz, Marcus Sandri, Ingo Eitel
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Summary:Background Left atrial appendage closure (LAAC) has emerged as an alternative to oral anticoagulation (OAC) for stroke prevention in patients with atrial fibrillation (AF). OAC treatment has been proven feasible in mild-to-moderate chronic kidney disease (CKD). In contrast, the optimal antithrombotic management of AF patients with end-stage renal disease (ESRD) is unknown and LAAC has not been proven in these patients in prospective randomized clinical trials. Objectives The objective of this study is to evaluate safety and efficacy of LAAC in patients with ESRD. Methods Patients undergoing LAAC were collected in a German multicenter real-world observational registry. A composite endpoint consisting of the occurrence of ischemic stroke/transient ischemic attack, systemic embolism, and/or major clinical bleeding was assessed. Patients with ESRD were compared with propensity score-matched patients without severe CKD. ESRD was defined as a glomerular filtration rate < 15 ml/min/1.73 m2 or chronic hemodialysis treatment. Results A total of 604 patients were analyzed, including 57 with ESRD and 57 propensity-matched patients. Overall, 596 endocardial and 8 epicardial LAAC procedures were performed. Frequency of major complications was 7.0% (42/604 patients) in the overall cohort, 8.8% (5/57 patients) in patients with ESRD, and 10.5% (6/57 patients) in matched controls (p = 0.75). The estimated event-free survival of the combined endpoint after 500 days was 90.7 ± 4.5% in patients with ESRD and 90.2 ± 5.5% in matched controls (p = 0.33). Conclusions LAAC had comparable procedural safety and clinical efficacy in patients with ESRD and patients without severe CKD.
Item Description:Online veröffentlicht: 22. Januar 2023
Gesehen am 08.08.2024
Physical Description:Online Resource
ISSN:1522-726X
DOI:10.1002/ccd.30559

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