B-40 | Safety and Efficacy of Combining Left Atrial Appendage Occlusion With Another Cardiac Procedure

Clinical outcomes of left atrial appendage occlusion (LAAO) combined with other cardiac procedures have not been previously examined. We aimed to evaluate the safety and efficacy of combining LAAO with other cardiac procedures vs. isolated LAAO. We conducted a retrospective cohort study using the 2016-2020 National Inpatient Sample to compare patients undergoing LAAO combined with another cardiac procedure vs. isolated LAAO. Outcomes included risk-adjusted major adverse cardiovascular events (MACE), in-hospital mortality, major complications, length of stay (LOS), and total costs. The total cohort included 88,910 weighted encounters, of which 1,225 (1.4%) involved concomitant cardiac procedures. After risk-adjustment, patients in the concomitant procedure group had similar odds of MACE (adjusted odds ratio [aOR] 1.82, 95% confidence interval [CI] 0.94-2.74), in-hospital mortality, and complications including stroke, acute kidney injury, major bleeding, blood transfusion, or vascular injury. They also had similar LOS (1 day vs. 1 day, p=0.32) and higher costs ($44,723 vs. $32,364, p<0.01) compared with isolated LAAO. In subgroup analyses, concomitant atrial fibrillation ablation had higher odds of heart block (p<0.01), and concomitant transcatheter aortic valve replacement had higher odds of stroke (p=0.02) and vascular injury (p<0.01). In this retrospective observational study,combining LAAO with another cardiac intervention appeared to be associated with similar MACE and LOS. However, certain complications appeared to be more frequent and the cost was higher with combined procedures.