Impact of LA Appendage Closure During Cardiac Surgery

Study Questions:

What is the association between left atrial appendage (LAA) closure and the risk of early postoperative atrial fibrillation (POAF), ischemic stroke, and mortality after routine non–AF-related cardiac surgery?

Methods:

Out of 10,633 adults who underwent coronary artery bypass grafting (CABG) and/or valve surgery between January 2000 and December 2005, 9,792 patients with complete baseline characteristics, surgery procedure, and follow-up data were included in this analysis. A propensity-score matching analysis based on 28 pretreatment covariates was performed, and 461 matching pairs were derived and analyzed to estimate the association of LAA closure with early POAF (AF ≤30 days of surgery), ischemic stroke, and mortality.

Results:

In the propensity-matched cohort, the overall incidence of POAF was 53.9%. In this group, the rate of early POAF among the patients who underwent LAA closure was 68.6% versus 31.9% for those who did not undergo the procedure (p < 0.001). LAA closure was independently associated with an increased risk of early POAF (adjusted odds ratio [95% confidence interval (CI)], 3.88 [2.89-5.20]), but did not significantly influence the risk of stroke (adjusted hazard ratio [95% CI], 1.07 [0.72-1.58]) or mortality (adjusted hazard ratio [95% CI], 0.92 [0.75-1.13]).

Conclusions:

The authors concluded that after adjustment for treatment allocation bias, LAA closure during routine cardiac surgery was significantly associated with an increased risk of early POAF, but did not influence the risk of stroke or mortality.

Perspective:

This study reports that LAA closure during routine non–AF-related cardiac surgery was associated with an increased risk of POAF irrespective of the type of surgery performed. LAA closure was associated with a nearly fourfold increased risk of POAF and did not significantly influence the risk of subsequent ischemic stroke or mortality. These findings suggest that potential risks and benefits of LAA elimination during routine non–AF-related cardiac surgery should be carefully considered before a procedure is performed. Future prospective studies are indicated to evaluate the long-term efficacy of surgical and other LAA closure/occlusion strategies in reducing the risk of stroke in patients with AF.


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