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Master Thesis

Fermeture de l’auricule gauche dans la fibrillation auriculaire chez les patients âgés de plus de 75 ans : étude observationnelle d’une cohorte de 73 patients menée au CHU de Bordeaux

Abstract : Introduction: atrial fibrillation is the heart arrhythmia the most frequent in the general population. The left appendage atrial occlusion is offered to patients showing high thromboembolic risks and presenting contraindication to anticoagulant. The aim of this study is to describe the follow-up of geriatrics patients who received this treatment in Bordeaux University Hospital in order to assess the success rate and the main complications. Method: an epidemiologic observational descriptive single-centered study of 73 patients over 75 was carried out in one the heart surgery unit in the hospital of Bordeaux between the 01/01/2013 and the 31/12/2016. The primary outcome was the appearance of major or minor complications which allowed us to calculate the intraoperative rate of success and those remote from the treatment. Results: 73 patients received this atrial occlusion. The average age was 81 ± 4 years, the score of CHA2DS2VASc 5 ± 1 years and the score HAS-BLED 4 ± 0.84. The success rate of the procedure was 100%. The intraprocedure rate of success was 94.5% and the rate of patients who did not present major complications or intracardiac thrombus was 80% two years after the treatment. During follow-up, 4 patients presented ischemic strokes, 5 patients an intracardiac thrombus, one patient presented a major hemorrhage after the surgery, a patient died because of a heart attack and another due to a neurologic reason. There was only one case of failure with a totally permeable prosthetic. The most frequent complication was the minor bleeding at the puncture spot. Our study shows a 60% diminution of the thromboembolic risk compared to the estimated risk by the average CHA2DS2VASc score of patients. Conclusion: the percutaneous left atrial appendage closure seems to be a reasonable solution as well as less risky for fragile geriatrics patients presenting a definitive contraindication for anticoagulants.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-02499528
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Last modification on : Friday, March 20, 2020 - 1:19:21 AM
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Xavier Rigaud. Fermeture de l’auricule gauche dans la fibrillation auriculaire chez les patients âgés de plus de 75 ans : étude observationnelle d’une cohorte de 73 patients menée au CHU de Bordeaux. Médecine humaine et pathologie. 2019. ⟨dumas-02499528⟩

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