Abstract：
BACKGROUND: Left atrial appendage closure (LAAC) was developed as a novel stroke prevention alternative for patients with atrial fibrillation, particularly for those not suitable for long-term oral anticoagulant therapy. Traditionally, general anesthesia (GA) has been more commonly used primarily due to the necessity of transesophageal echocardiography.
OBJECTIVE: Compare trends of monitored anesthesia care (MAC) versus GA for percutaneous transcatheter LAAC with endocardial implant and assess for independent variables associated with primary anesthetic choice.
METHODS: Multi-institutional data collected from across the United States using the National Anesthesia Clinical Outcomes Registry.
METHODS: Retrospective data analysis from 2017-2021.
METHODS: Independent-sample t tests or Mann-Whitney U tests were used for continuous variables and Chi-square tests or Fisher\'s exact test for categorical variables. Multivariate logistic regression was used to assess patient and hospital characteristics.
RESULTS: A total of 19,395 patients underwent the procedure, and 352 patients (1.8%) received MAC. MAC usage trended upward from 2017-2021 (P < 0.0001). MAC patients were more likely to have an American Society of Anesthesiologists (ASA) physical status of≥ 4 (33.6% vs 22.89%) and to have been treated at centers in the South (67.7% vs 44.2%), in rural locations (71% vs 39.5%), and with lower median annual percutaneous transcatheter LAAC volume (102 vs 153 procedures) (all P < 0.0001). In multivariate analysis, patients treated in the West had 85% lower odds of receiving MAC compared to those in the Northeast (AOR: 0.15; 95% CI 0.03-0.80, P = 0.0261).
CONCLUSIONS: While GA is the most common anesthetic technique for percutaneous transcatheter closure of the left atrial appendage, a small, statistically significant increase in MAC occurred from 2017-2021. Anesthetic management for LAAC varies with geographic location.
OBJECTIVE: Compare trends of monitored anesthesia care (MAC) versus GA for percutaneous transcatheter LAAC with endocardial implant and assess for independent variables associated with primary anesthetic choice.
METHODS: Multi-institutional data collected from across the United States using the National Anesthesia Clinical Outcomes Registry.
METHODS: Retrospective data analysis from 2017-2021.
METHODS: Independent-sample t tests or Mann-Whitney U tests were used for continuous variables and Chi-square tests or Fisher\'s exact test for categorical variables. Multivariate logistic regression was used to assess patient and hospital characteristics.
RESULTS: A total of 19,395 patients underwent the procedure, and 352 patients (1.8%) received MAC. MAC usage trended upward from 2017-2021 (P < 0.0001). MAC patients were more likely to have an American Society of Anesthesiologists (ASA) physical status of≥ 4 (33.6% vs 22.89%) and to have been treated at centers in the South (67.7% vs 44.2%), in rural locations (71% vs 39.5%), and with lower median annual percutaneous transcatheter LAAC volume (102 vs 153 procedures) (all P < 0.0001). In multivariate analysis, patients treated in the West had 85% lower odds of receiving MAC compared to those in the Northeast (AOR: 0.15; 95% CI 0.03-0.80, P = 0.0261).
CONCLUSIONS: While GA is the most common anesthetic technique for percutaneous transcatheter closure of the left atrial appendage, a small, statistically significant increase in MAC occurred from 2017-2021. Anesthetic management for LAAC varies with geographic location.
摘要：
背景：左心耳封堵术（LAAC）被开发为房颤患者的新型卒中预防选择，特别是对于那些不适合长期口服抗凝治疗。传统上,全身麻醉（GA）的使用更普遍，主要是由于需要经食管超声心动图检查。
目的：比较经皮导管LAAC和心内膜植入的监测麻醉护理（MAC）与GA的趋势，并评估与主要麻醉选择相关的独立变量。
方法：使用国家麻醉临床结果注册从美国各地收集的多机构数据。
方法：2017-2021年回顾性数据分析。
方法：连续变量采用独立样本t检验或Mann-WhitneyU检验，分类变量采用卡方检验或Fisher精确检验。多因素logistic回归用于评估患者和医院特征。
结果：共有19,395名患者接受了手术，352名患者（1.8%）接受MAC治疗。2017-2021年MAC使用率呈上升趋势（P<0.0001）。MAC患者更可能有美国麻醉医师协会（ASA）的身体状况≥4（33.6％vs22.89％），并且在南方的中心接受过治疗（67.7％vs44.2％）。在农村地区(71%对39.5%)，并且年中位经皮导管LAAC体积较低（102例vs153例）（所有P<0.0001）。在多变量分析中，与东北地区相比,在西部接受治疗的患者接受MAC治疗的几率降低85%(AOR:0.15;95%CI0.03-0.80,P=0.0261).
结论：虽然GA是经皮左心耳封堵术中最常用的麻醉技术，一个小,从2017年至2021年，MAC的统计显着增加。LAAC的麻醉管理因地理位置而异。
目的：比较经皮导管LAAC和心内膜植入的监测麻醉护理（MAC）与GA的趋势，并评估与主要麻醉选择相关的独立变量。
方法：使用国家麻醉临床结果注册从美国各地收集的多机构数据。
方法：2017-2021年回顾性数据分析。
方法：连续变量采用独立样本t检验或Mann-WhitneyU检验，分类变量采用卡方检验或Fisher精确检验。多因素logistic回归用于评估患者和医院特征。
结果：共有19,395名患者接受了手术，352名患者（1.8%）接受MAC治疗。2017-2021年MAC使用率呈上升趋势（P<0.0001）。MAC患者更可能有美国麻醉医师协会（ASA）的身体状况≥4（33.6％vs22.89％），并且在南方的中心接受过治疗（67.7％vs44.2％）。在农村地区(71%对39.5%)，并且年中位经皮导管LAAC体积较低（102例vs153例）（所有P<0.0001）。在多变量分析中，与东北地区相比,在西部接受治疗的患者接受MAC治疗的几率降低85%(AOR:0.15;95%CI0.03-0.80,P=0.0261).
结论：虽然GA是经皮左心耳封堵术中最常用的麻醉技术，一个小,从2017年至2021年，MAC的统计显着增加。LAAC的麻醉管理因地理位置而异。
