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The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
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Does left atrial appendage ligation during coronary bypass surgery decrease the incidence of postoperative stroke?

Yen-Yi Juo1, Katherine Lee Bailey2, Young-Ji Seo2

  • 1Center for Advanced Surgical and Interventional Technology, University of California, Los Angeles, Los Angeles, Calif; Department of Surgery, George Washington University, Washington, DC.

The Journal of Thoracic and Cardiovascular Surgery
|April 5, 2018
PubMed
Summary
This summary is machine-generated.

Surgical left atrial appendage ligation did not reduce stroke risk in atrial fibrillation patients undergoing coronary artery bypass grafting. The study found no significant association between this procedure and lower postoperative stroke incidence.

Keywords:
atrial fibrillationcoronary artery bypass graftleft atrial appendagestroke

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Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Vascular Surgery

Background:

  • Atrial fibrillation is a common comorbidity in patients undergoing coronary artery bypass grafting (CABG).
  • Stroke is a significant risk following CABG, particularly in patients with atrial fibrillation.
  • Left atrial appendage (LAA) ligation is a surgical technique sometimes employed to reduce stroke risk in these patients.

Purpose of the Study:

  • To evaluate the association between surgical left atrial appendage ligation and in-hospital stroke incidence.
  • To assess the impact of LAA ligation on stroke risk in patients with atrial fibrillation undergoing CABG.

Main Methods:

  • Retrospective cohort study using the Nationwide Inpatient Sample (2008-2014).
  • Included patients with atrial fibrillation who underwent CABG, categorized into LAA ligation or control groups.
  • Propensity score-weighted regression analyses were used to assess outcomes.

Main Results:

  • A total of 234,642 patients were analyzed; 8.81% underwent LAA ligation.
  • The national postoperative stroke incidence was 0.92%.
  • LAA ligation was not significantly associated with reduced postoperative stroke (OR, 0.83; P=.35), pericardial complications (OR, 1.15; P=.31), hemorrhage (OR, 1.08; P=.07), mortality (OR, 1.29; P=.06), or altered length of stay (P=.08).

Conclusions:

  • Postoperative stroke risk after CABG in atrial fibrillation patients is low (~1%).
  • Concomitant LAA ligation during CABG was not associated with a lower risk of postoperative stroke.
  • No specific CHA2DS2-VASc score threshold demonstrated a benefit of LAA ligation for reducing stroke risk.