For patients over 90 years old, is there any foreseeable benefit to undergoing left atrial appendage occlusion over permanent cessation of anticoagulation, particularly for those at high risk for major bleeding?

I would have no qualms about referring a 90+ year-old patient with a-fib and high bleeding risk for an LAA occlusion device. However, this requires a shared decision-making process whereby the risks and benefits of the various treatment options are discussed with the patient and, when appropriate, the patient's family.

I don’t think age/number alone should ever be a deciding factor.

I recently sent a patient in their 90s in chronological age but looked more like a 79-year-old for TAVR (fully functional, healthy, active, and of clear mind). But was limited by shortness of breath/fatigue/weakness with exertion.

I saw her back this past week after post-procedure and she was overjoyed with her increased energy level, and degree of improvement in daily activity. She felt like a new person.