Safety of left atrial appendage amputation in cardiac surgery patients without atrial fibrillation.

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.