Abstract 318 Left Atrial Appendage Closure in End-stage Renal Disease and Hemodialysis: Data from a German Multicenter Registry

Clin Res Cardiol (2021). 10.1007/s00392-021-01933-9
Left Atrial Appendage Closure in End-stage Renal Disease and Hemodialysis: Data from a German Multicenter Registry
T. Fink¹, C. Paitazoglou², M. W. Bergmann², M. Sano³, A. Keelani³, V. Sciacca¹, M. Saad⁴, C. Eitel⁴, C.-H. Heeger⁵, C. Skurk⁶, U. Landmesser⁶, H. Thiele⁷, T. Stiermaier⁵, G. Fürnau⁵, J.-C. Reil⁵, N. Frey⁸, K.-H. Kuck⁹, R. R. Tilz⁵, M. Sandri⁷, I. Eitel⁵
¹Elektrophysiologie/ Rhythmologie, Herz- und Diabeteszentrum NRW, Bad Oeynhausen; ²Cardiologicum Hamburg, Hamburg; ³UKSH Lübeck, Lübeck; ⁴Med. Klinik II / Kardiologie, Elektrophysiologie, Universitätsklinikum Schleswig-Holstein, Lübeck; ⁵Medizinische Klinik II / Kardiologie, Angiologie, Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Lübeck; ⁶CC 11: Med. Klinik für Kardiologie, Charité - Universitätsmedizin Berlin, Berlin; ⁷Klinik für Innere Medizin/Kardiologie, Herzzentrum Leipzig - Universität Leipzig, Leipzig; ⁸Klinik für Innere Med. III, Kardiologie, Angiologie u. Pneumologie, Universitätsklinikum Heidelberg, Heidelberg; ⁹Kardiologie, LANS Cardio Hamburg, Hamburg;
Background: Left atrial appendage closure (LAAC) has emerged as 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: 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/TIA, systemic embolism and/or major clinical bleeding was assessed. Patients with ESRD were compared to propensity score-matched patients without severe CKD. ESRD was defined as a glomerular filtration rate <15ml/min/1.73m² 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). Kaplan Meier estimation of event-free survival according to renal function (GFR >30ml/h, 15-29ml/h and <15ml/h) reached a statistical trend for differences among groups, but did not reach statistical significance (p=0.057, Figure 1). 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 was comparable with regards to procedural safety and clinical efficacy in patients with ESRD and patients without severe CKD. Figure 1 Kaplan Meier estimation of event-free survival of clinical endpoints The combined endpoint consisted of ischemic stroke, TIA, system embolism and/or major clinical bleeding (A). Estimated event-free survival for ischemic stroke, TIA or thromboembolism (B) and major clinical bleeding (C).
https://dgk.org/kongress_programme/ht2021/P446.htm