Multiples Interventions and Risk in the Elderly Population
In the frail and elderly population referred for LAAC, patients harbor several cardiac and extracardiac comorbidities (23). This clinical status leads to both: 1. higher risk of requiring multiple cardiac interventions; and 2. higher risk of complications when these cardiac interventions are performed. Moreover, multiple, and repeated hospitalizations and anesthesia in the elderly population can result in periprocedural complications unrelated to the initial clinical condition that prompted the admission or to the procedure itself (24). Thus, a strategy combining LAAC and another cardiac structural or electrophysiological intervention in a single intervention appears attractive. In fact, the combined strategy may decrease hospitalizations and the length of stay and will require only one anesthesia/sedation. On the other hand, due to physiological and pathological changes that occur with age, patients maybe at higher risk of periprocedural morbidity and mortality (25,26). Thus, the combined strategy had to be studied to demonstrate equal or even superior benefits in term of efficacy and safety. In our small cohort, despite similar baseline characteristics, the rates of technical and procedural success and periprocedural complications were not different in patients who underwent the combined strategy compared to those who underwent the single LAAC. These results strengthen the feasibility and safety of the concomitant approach previously described in the Swiss series using the AmplatzerTM devices (16).