Same-day discharge after LAAO is safe, cost-effective and ‘could become the new standard’
Same-day discharge (SDD) for percutaneous left atrial appendage occlusion (LAAO) is safe and effective, according to new findings published in the Journal of Invasive Cardiology.
“By avoiding general anesthesia, a same-day strategy using intracardiac echocardiography and conscious sedation may be safer and translate into reduced hospital stay and expedited procedural turnaround,” wrote first author Luis Augusto Palma Dallan, MD, PhD, of the division of cardiology at Harrington Heart & Vascular Institute in Cleveland, and colleagues. “During the COVID-19 pandemic, we implemented a SDD strategy to reduce possible in-hospital virus exposure and to ease bed strain by reducing length of stay.”
The team’s analysis included data from 23 patients who underwent LAAO with the Watchman device using their newly developed SDD protocol. The protocol included CT pre-procedural planning, access site hemostasis using closure device or manual pressure and a post-implant transthoracic echocardiogram. All patients were treated at a single U.S. facility from June to December 2020. The mean patient age was 74.4 years old.
Those 23 patients were then compared to another 119 patients who had previously undergone the same procedure with a traditional approach that included general anesthesia.
Overall, all procedures completed using the SDD protocol were successful. There was also “no significant difference” in procedural complications or in-hospital adverse outcomes. Outcomes after 45 days were also similar.
In addition, the mean procedure time was 11 minutes longer among SDD patients. The team also estimated that SDD was associated with a 15% reduction in total costs, though they were unable to provide financial data specific to the facility in question.
“As far as we know, this is the first prospective study comparing the safety, feasibility, and cost-effectiveness of the same-day discharge strategy with a conventional approach,” the authors wrote. “Our study demonstrates that the majority of patients can safely be discharged from LAAO on the same day of their procedure and with lower overall cost.”
Some study authors did report prior relationships with Boston Scientific, the manufacturer of the Watchman device.
Click here for the full study.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.