Left atrial appendage occlusion in vulnerable oldest-old patients: effectiveness and safety in a large single-center registry
Background and aim - Complex periprocedural approaches contrast with the need of oldest-old patients to keep medical procedures simple and short. This study investigates the effectiveness and safety of a simplified non-complex LAAO procedure. - Methods - All patients who received an LAAO procedure a...
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| Main Authors: | , , , , , , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
15 June 2025
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| In: |
Journal of the neurological sciences
Year: 2025, Volume: 473, Pages: 1-7 |
| ISSN: | 1878-5883 |
| DOI: | 10.1016/j.jns.2025.123521 |
| Online Access: | Verlag, kostenfrei, Volltext: https://doi.org/10.1016/j.jns.2025.123521 Verlag, kostenfrei, Volltext: https://www.sciencedirect.com/science/article/pii/S0022510X25001388 
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| Author Notes: | Christian Fastner, Enise Tavas, Svetlana Hetjens, Mathieu Kruska, Uzair Ansari, Michael Behnes, Juergen Kuschyk, Daniel Duerschmied, Heinrich Burkhardt, Angelika Alonso, Ibrahim Akin |
| Summary: | Background and aim - Complex periprocedural approaches contrast with the need of oldest-old patients to keep medical procedures simple and short. This study investigates the effectiveness and safety of a simplified non-complex LAAO procedure. - Methods - All patients who received an LAAO procedure at our center since 2014 with available follow-up data were retrospectively assessed concerning effectiveness in preventing all-cause death, stroke, or systemic embolism (i.e., effectiveness outcome). Safety was primarily evaluated by major bleeding (i.e., ≥ BARC type 3). Oldest-old patients (i.e., ≥ 80 years of age) were compared with younger patients. - Results - 43.0 % of 230 patients were oldest-olds. High technical success rate was achieved in both groups (oldest-olds 96.0 vs. younger patients 98.5 %; p = 0.41). Major complications occurred in 8.1 vs. 3.8 % of patients (p = 0.17). Effectiveness outcome was achieved in 70.7 vs. 82.4 % of patients (p = 0.035; mean follow-up 428 (100; 1007) and 382 (179; 1192) days). Oldest-old patients trended to an excess mortality (22.2 vs. 13.0 %; p = 0.064) and more ischemic strokes (10.1 vs. 3.8 %; p = 0.056). This was not associated with peri-device leaks ≥ 5 mm or device-related thromboses (2.0 vs. 1.5 %; p = 1.00). Major bleeding occurred in 9.1 vs. 7.6 % of patients over total follow-up (p = 0.69). - Conclusions - Non-complex LAAO procedure achieved a state-of-the-art technical success rate and a low complication rate in vulnerable oldest-old patients. Care should be taken to identify patients with sufficient life expectancy to benefit from LAAO. The trend towards more ischemic strokes during follow-up is an important signal focusing on cardioembolic stroke etiologies besides LAA thrombi in these patients. |
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| Item Description: | Online verfügbar: 28. April 2025, Artikelversion: 9. Mai 2025 Gesehen am 25.09.2025 |
| Physical Description: | Online Resource |
| ISSN: | 1878-5883 |
| DOI: | 10.1016/j.jns.2025.123521 |