{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T10:32:23Z","timestamp":1782469943753,"version":"3.54.5"},"reference-count":25,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2023,11,20]],"date-time":"2023-11-20T00:00:00Z","timestamp":1700438400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Percutaneous left-atrial appendage (LAA) occlusion is an important therapeutic option for preventing cardioembolic stroke in patients with non-valvular atrial fibrillation (AF) at high risk of thromboembolic events and with contraindications for oral anticoagulation (OAC). It is usually performed with transesophageal echocardiography (TOE) guidance under general anesthesia (GA). In this retrospective study, we present a multicenter experience of LAA occlusion performed with conscious sedation (CS) without an anesthesiologist on site. Materials and Methods: All the patients on the waiting list for LAA occlusion procedure at Infermi Hospital, Rivoli, and San Luigi Gonzaga University Hospital, Orbassano, from October 2018 to October 2022 were analyzed. All the procedures were performed with a Watchman\/FLX LAA closure device under TOE and fluoroscopic guidance without an anesthesiologist on site. CS was performed with a combination of midazolam and fentanyl as needed. Results: One-hundred fifteen patients were included (age 76.4 \u00b1 7.6 years, median CHA2DS2Vasc 4.4 \u00b1 1.4). CS was performed using midazolam (mean dose 5.9 \u00b1 2.1 mg), adding fentanyl for thirty-nine (33.9%) patients in case of poor tolerance for the procedure despite midazolam. The acute procedural success rate was 99.1%. We observed seven acute severe complications. No patients needed anesthesiological assistance during the procedure, and no cases of respiratory failure necessitating ventilation were reported. In a follow-up after 10 \u00b1 9 months, one case of stroke (0.9%) and one case (0.9%) of transient ischemic attack (TIA) occurred. Conclusions: LAA occlusion performed under CS and without the presence of an anesthesiologist on site appears to be safe and effective. It can be an attractive alternative to general anesthesia (GA), as fewer resources are required.<\/jats:p>","DOI":"10.3390\/medicina59112041","type":"journal-article","created":{"date-parts":[[2023,11,20]],"date-time":"2023-11-20T01:54:12Z","timestamp":1700445252000},"page":"2041","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Clinical Outcomes of Percutaneous Left-Atrial Appendage Occlusion with Conscious Sedation without an Anesthesiologist on Site: Results from a Multicenter Study"],"prefix":"10.3390","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6751-6437","authenticated-orcid":false,"given":"Matteo","family":"Bianco","sequence":"first","affiliation":[{"name":"Cardiology Division, San Luigi Gonzaga University Hospital, 10043 Orbassano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea Carmelo","family":"Visalli","sequence":"additional","affiliation":[{"name":"Cardiology Division, San Luigi Gonzaga University Hospital, 10043 Orbassano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Tomassini","sequence":"additional","affiliation":[{"name":"Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano and Infermi Hospital, 10098 Rivoli, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carloalberto","family":"Biol\u00e8","sequence":"additional","affiliation":[{"name":"Cardiology Division, San Luigi Gonzaga University Hospital, 10043 Orbassano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1176-4300","authenticated-orcid":false,"given":"Federico","family":"Giacobbe","sequence":"additional","affiliation":[{"name":"Cardiology Division, San Luigi Gonzaga University Hospital, 10043 Orbassano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Rolfo","sequence":"additional","affiliation":[{"name":"Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano and Infermi Hospital, 10098 Rivoli, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1260-7534","authenticated-orcid":false,"given":"Enrico","family":"Cerrato","sequence":"additional","affiliation":[{"name":"Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano and Infermi Hospital, 10098 Rivoli, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4033-6636","authenticated-orcid":false,"given":"Alfonso","family":"Franz\u00e8","sequence":"additional","affiliation":[{"name":"Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano and Infermi Hospital, 10098 Rivoli, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Greca","family":"Zanda","sequence":"additional","affiliation":[{"name":"Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano and Infermi Hospital, 10098 Rivoli, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Pavani","sequence":"additional","affiliation":[{"name":"Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano and Infermi Hospital, 10098 Rivoli, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8460-5847","authenticated-orcid":false,"given":"Amir Hassan","family":"Mousavi","sequence":"additional","affiliation":[{"name":"Cardiology Division, San Luigi Gonzaga University Hospital, 10043 Orbassano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Gobello","sequence":"additional","affiliation":[{"name":"Cardiology Division, San Luigi Gonzaga University Hospital, 10043 Orbassano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulio","family":"Piedimonte","sequence":"additional","affiliation":[{"name":"Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano and Infermi Hospital, 10098 Rivoli, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paola","family":"Destefanis","sequence":"additional","affiliation":[{"name":"Cardiology Division, San Luigi Gonzaga University Hospital, 10043 Orbassano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maurizio","family":"Lazzero","sequence":"additional","affiliation":[{"name":"Cardiology Division, San Luigi Gonzaga University Hospital, 10043 Orbassano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Palacio Restrepo","sequence":"additional","affiliation":[{"name":"Cardiology Division, Infermi Hospital, 10098 Rivoli, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3535-3661","authenticated-orcid":false,"given":"Dario","family":"Celentani","sequence":"additional","affiliation":[{"name":"Cardiology Division, Infermi Hospital, 10098 Rivoli, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessia","family":"Luciano","sequence":"additional","affiliation":[{"name":"Cardiology Division, San Luigi Gonzaga University Hospital, 10043 Orbassano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emanuele","family":"Tizzani","sequence":"additional","affiliation":[{"name":"Cardiology Division, Infermi Hospital, 10098 Rivoli, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandra","family":"Chinaglia","sequence":"additional","affiliation":[{"name":"Cardiology Division, San Luigi Gonzaga University Hospital, 10043 Orbassano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ferdinando","family":"Varbella","sequence":"additional","affiliation":[{"name":"Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano and Infermi Hospital, 10098 Rivoli, Italy"},{"name":"Cardiology Division, Infermi Hospital, 10098 Rivoli, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,11,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1161\/CIRCULATIONAHA.113.005119","article-title":"Worldwide epidemiology of atrial fibrillation: A Global Burden of Disease 2010 Study","volume":"129","author":"Chugh","year":"2014","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"723","DOI":"10.1093\/europace\/eur126","article-title":"Bleeding risk assessment and management in atrial fibrillation patients: A position document from the European Heart 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