Background
Severe renal impairment (SRI) is associated with adverse clinical outcomes, and evidence-based recommendations for long-term oral anticoagulation remain limited in this population. Percutaneous left atrial appendage closure (LAAC) is an established alternative for stroke prevention in atrial fibrillation patients. However, the safety and effectiveness of LAAC in patients with SRI remain unclear.
Methods
The single-center HANSE-LAAC registry included all consecutive patients who underwent percutaneous LAAC between January 2014 and October 2024. Procedural outcomes and standardized follow-ups at 3 and 12 months were analyzed retrospectively. Patients were stratified by SRI status (glomerular filtration rate <15 mL/min/1.73 m² or chronic dialysis). Safety and efficacy endpoints were compared using Cox proportional hazards models.
Results
Of 508 patients treated with LAAC, 41 (8.1%) had SRI, including 32 (78%) on dialysis. Compared with non-SRI patients, those with SRI were younger (SRI 74.5 ± 9.3 vs non-SRI 77.4 ± 7.7 years; p=0.06), less frequently female (SRI 24% vs non-SRI 35%; p=0.14), and exhibited a higher prevalence of heart failure (SRI 54% vs non-SRI 36%; p=0.02) and lower left ventricular ejection fraction (SRI 45.7% vs non-SRI 49.9%; p=0.04). Prior strokes (SRI 33% vs non-SRI 63%; p=0.008) and major bleeding (SRI 27% vs non-SRI 46%; p=0.02) were more common in non-SRI patients. Procedural success and in-hospital outcomes were similar between groups. During one-year follow-up, all-cause mortality (SRI HR 1.52, 95% CI 0.88–2.11; p=0.20), cardiac death (HR 1.18, 95% CI 0.67–1.34; p=0.45), cardiovascular events (HR 1.29, 95% CI 0.88–1.55; p=0.38), rates of stroke or transient ischemic attack (HR 1.24, 95% CI 0.72–1.98; p=0.40), major bleeding (HR 1.42, 95% CI 0.69–1.78; p=0.35), as well as rehospitalization (HR 1.02, 95% CI 0.55–1.45; p=0.80) did not differ significantly. Device-related thrombus and peri-device leak at first follow-up were also comparable.
Conclusion
In this high-risk cohort, LAAC in patients with SRI was safe and demonstrated similar efficacy to that observed in patients without severe renal dysfunction. Ongoing randomized controlled trials will help further clarify the role of LAAC in this vulnerable population.
