Abstract 4146514: Safety and Contemporary Trends of Left Atrial Appendage Occlusion in Patients 85 Years and Older versus Less Than 85 Years

Background: There is a relative lack of comparative effectiveness research on the safety profile of left atrial appendage occlusion devices (LAAO) in patients ≥ over 85 years of age. Hypothesis: We hypothesize that patients who underwent LAAO older than 85 years will have similar odds of mortality and post-procedure complications when compared with younger patients. Aim: We aim to examine the safety of the in-hospital mortality and immediate complications of patients ≥85 years who underwent LAAO compared to those < 85 years. Methods: Patients undergoing LAAO from 2016-2021 were queried from the National Inpatient Sample. Using propensity score matching, patients were matched into two cohorts based on age ( ≥85 years and <85 years) in a 1:1 fashion using the ≥85 cohort as the dependent variable. In-patient mortality, post-procedure complications, and LAAO placement trends were compared using logistic regression models. The total complication outcome summarizes pericardial, cardiac, pulmonary, vascular, renal, neurologic, and infectious complications. Results: 136,075 patients underwent LAAO; each group included 19,015 patients. The overall mean age for the older group was 87.2 ± 1.0 years vs. 74.2 ± 5.1 years for the younger cohort. There were no associations between the two cohorts in in-patient mortality and total complications (aOR 1.40; 95% CI 0.44-4.42; p= 0.57) and (aOR 0.89; 95% CI: 0.79-1.01; p= 0.07). There was no significant difference in major circulatory events (aOR 0.85; 95% CI 0.75-1.01), but the odds of bleeding requiring transfusion were higher in the older cohort compared to the younger cohort (aOR 2.19; 95% CI 1.10-4.37). Overall, total complications and major cardiac, vascular, circulatory, renal, and neurologic complications were not statistically significantly different between cohorts. There was a significant increase in LAAO placement from 2016 to 2021 in both cohorts [>85 (p= 0.04);<85 (p= 0.02)] Conclusion: In the 2016-2021 National Inpatient Sample, patients who underwent LAAO aged ≥85 had comparable inpatient mortality and post-procedure complications to younger patients. These results contribute to the growing body of evidence supporting the safety of LAAO in elderly patients aged 85 and above.