CBS 2019
CBSMD教育中心
中 文

Transcatheter Aortic Valve Replacement

Abstract

Recommended Article

Transcatheter aortic-valve replacement with a self-expanding prosthesis 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines Transcatheter Aortic Valve Replacement in Patients With Multivalvular Heart Disease Predictors and Clinical Outcomes of Next-Day Discharge After Minimalist Transfemoral Transcatheter Aortic Valve Replacement Conscious Sedation Versus General Anesthesia for Transcatheter Aortic Valve Replacement: Variation in Practice and Outcomes Long-Term Durability of Transcatheter Heart Valves: Insights From Bench Testing to 25 Years Contemporary real-world outcomes of surgical aortic valve replacement in 141,905 low-risk, intermediate-risk, and high-risk patients Early Surgery or Conservative Care for Asymptomatic Aortic Stenosis

Original Research2020 Nov 24;S0167-5273(20)34168-1.

JOURNAL:Int J Cardiol. Article Link

Left atrial appendage occlusion in atrial fibrillation patients with previous intracranial bleeding: A national multicenter study

G Casu, G D'Angelo, P Merella et al. Keywords: atrial fibrillation; high bleeding risk; intracranial hemorrhage; left atrial appendage occlusion; optimal therapy after left atrial appendage occlusion; previous intracranial bleeding

ABSTRACT

BACKGROUND - Intracranial hemorrhage (ICH) represents the most serious complication of oral anticoagulant therapy (OAT) in patients with atrial fibrillation (AF), and AF patients with previous ICH are a challenge for clinicians. Left atrial appendage (LAA) occlusion has emerged as an alternative option for AF patients not suitable for OAT. Currently, few data are available on long term outcomes after LAA occlusion in this population. We evaluated the safety and efficacy of LAA occlusion in a cohort of patients with AF and previous ICH.

METHODS - This is a multicenter, observational, retrospective study involving 5 LAA occlusion centers in Italy. It includes all consecutive patients (n = 120) with previous ICH who underwent LAA occlusion for nonvalvular AF and high thromboembolic risk. Procedural outcomes, post-procedural therapies and 12-months follow-up data were analyzed.

RESULTS - The device was successfully implanted in 100% of cases, with a 6% of major peri-procedural complications. 59% had a prior ICH during OAT. The sample had a high risk of stroke (5.18%/year) and bleeding (6.62%/year). 30% were discharged on single and 54.2% on dual antiplatelet therapy. The expected annual risk for thromboembolism was 5.1%. Excluding periprocedural ischemic complications, the stroke annual rate was 1.8%. The expected annual risk of bleeding was 6.7%. The observed annual bleeding rate was 5.45%.

CONCLUSIONS - Percutaneous LAA occlusion is an effective option for AF patients and previous intracranial hemorrhage. After LAA occlusion, a single antiplatelet therapy strategy could be considered for patients with the highest risk of recurrent bleeding.



Copyright © 2020. Published by Elsevier B.V.