B-39 | Cerebrovascular accidents and mortality following left atrial appendage occlusion in patients with moderate and severe chronic renal impairment: a comprehensive meta-analysis

Left Atrial Appendage Occlusion (LAAO)is as an effective approach of preventing stroke in individuals suffering from persistent atrial fibrillation. Chronic kidney dysfunction breaks down the coagulation system, giving rise to an unforeseen outcome post LAAO. We aimed to assess mortality and cerebrovascular events subsequent to LAAO in patients with various stages of chronic renal disease. Studies comparing post- LAAO mortality rate and stroke incidence between CKD and non-CKD patients were considered eligible to be analyzed. Also, a meta-analysis was planned to observe whether the mentioned outcomes occurred while end-stage renal disease (ESRD) or not. All statistical analyses were performed using R software. 13 investigations comprising 56041 patients were included. Post-LAAO mortality rate seemed to be higher in those having concomitant CKD (OR= 2.46[2.00-3.03], I2= 0%). However stroke/TIA incidence did not indicate a significant difference between the groups. ESRD was associated with a higher odds of mortality (OR= 3.19[1.22-8.38], I2= 82%) and stroke/TIA (OR= 4.17[2.97-5.85], I2= 0%) following LAAO. Our findings revealed that the efficacy of LAAO might not be different between individuals with or without CKD. However, the mortality rate was still higher. On the other hand, ESRD patients seemed to show considerably poorer outcomes following the procedure. This makes a huge demand for researchers to design highly qualified clinical trials to observe which treatment strategy (novel anticoagulants or LAAO) will be more successful managing AF while severe CKD.