Heart rhythm · 2025
Safety of left atrial appendage amputation in cardiac surgery patients without atrial fibrillation.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Terpstra Marc M, van der Ree Martijn H, Neefs Jolien, van den Berg Nicoline W E, Hulsman Elise L, Meijer Ilse, Dong Zhenyu, Terreros Nerea Arrarte, van Boven Wim Jan P, de Jong Jonas S S G, van Putte Bart P, Driessen Antoine H G, Boersma Lucas V A, de Groot Joris R
Аннотация
BACKGROUND: Left atrial appendage amputation (LAAA) lowers the stroke risk in patients with atrial fibrillation (AF), but its safety and functional implications in non-AF patients are uncertain.
OBJECTIVE: We aimed to assess early post-operative safety of LAAA in non-AF patients undergoing cardiac surgery.
METHODS: This retrospective cohort study included 434 patients without AF (CHA2DS2-VASc ≥2) who underwent elective cardiac surgery at 2 centers (2015-2018). We compared 150 patients who underwent LAAA as part of the PREventive left atrial appenDage resection for the predICtion of fuTure Atrial Fibrillation (PREDICT-AF) study, with 284 patients who declined participation and did not undergo LAAA. The primary end point was a composite of major complications and supraventricular tachycardias within 30 days. Secondary outcomes included individual complications, arrhythmias, and surrogate markers for fluid overload (weight changes, diuretic use, blood pressure, and chest x-ray congestion). Repeated measures were compared using linear mixed-effects models. 1:1 Propensity score matching was performed to assess outcomes in balanced groups.
RESULTS: The LAAA group had more men (87% vs 73%, P = .001) and were heavier (86 kg [95% confidence interval: 80-92] vs 82 kg [confidence interval: 72-91], P = .001). No significant differences were observed in the primary end point (47% vs 41%, P = .321) or post-operative AF (38% vs 32%, P = .225). Atrial tachycardias were uncommon but more frequent in the LAAA cohort (4% vs 0.4%, P = .014). Procedural times and markers for fluid overload did not differ. Propensity score matching confirmed no important differences between cohorts.
CONCLUSION: Concomitant LAAA was not associated with increased surgical complications, post-operative AF, or fluid overload in patients without a history of AF. These findings suggest LAAA may be a safe strategy for stroke prevention in patients undergoing cardiac surgery.
OBJECTIVE: We aimed to assess early post-operative safety of LAAA in non-AF patients undergoing cardiac surgery.
METHODS: This retrospective cohort study included 434 patients without AF (CHA2DS2-VASc ≥2) who underwent elective cardiac surgery at 2 centers (2015-2018). We compared 150 patients who underwent LAAA as part of the PREventive left atrial appenDage resection for the predICtion of fuTure Atrial Fibrillation (PREDICT-AF) study, with 284 patients who declined participation and did not undergo LAAA. The primary end point was a composite of major complications and supraventricular tachycardias within 30 days. Secondary outcomes included individual complications, arrhythmias, and surrogate markers for fluid overload (weight changes, diuretic use, blood pressure, and chest x-ray congestion). Repeated measures were compared using linear mixed-effects models. 1:1 Propensity score matching was performed to assess outcomes in balanced groups.
RESULTS: The LAAA group had more men (87% vs 73%, P = .001) and were heavier (86 kg [95% confidence interval: 80-92] vs 82 kg [confidence interval: 72-91], P = .001). No significant differences were observed in the primary end point (47% vs 41%, P = .321) or post-operative AF (38% vs 32%, P = .225). Atrial tachycardias were uncommon but more frequent in the LAAA cohort (4% vs 0.4%, P = .014). Procedural times and markers for fluid overload did not differ. Propensity score matching confirmed no important differences between cohorts.
CONCLUSION: Concomitant LAAA was not associated with increased surgical complications, post-operative AF, or fluid overload in patients without a history of AF. These findings suggest LAAA may be a safe strategy for stroke prevention in patients undergoing cardiac surgery.