Association of Surgical Left Atrial Appendage Occlusion With Subsequent Stroke and Mortality Among Patients...

Area of Science:

• Cardiology
• Cardiac Surgery
• Electrophysiology

Background:

• Surgical occlusion of the left atrial appendage (LAAO) is performed during cardiac surgery.
• Limited data exist on LAAO's long-term association with stroke risk and subsequent atrial fibrillation (AF).

Purpose of the Study:

• To evaluate the association of surgical LAAO during cardiac surgery with risks of stroke, mortality, and subsequent AF development.

Main Methods:

• Retrospective cohort study of adult patients undergoing coronary artery bypass graft or valve surgery.
• Utilized a large US administrative database with propensity score matching to compare patients with and without LAAO.
• Stratified analysis based on history of prior AF at the time of surgery.

Main Results:

• In propensity score-matched patients, LAAO was associated with reduced risk of stroke (HR, 0.73) and mortality (HR, 0.71).
• LAAO was associated with higher rates of AF-related outpatient visits and hospitalizations.
• In patients with prior AF, LAAO reduced stroke (HR, 0.68) and mortality (HR, 0.67) risks; in patients without prior AF, LAAO did not significantly reduce stroke or mortality but increased postoperative AF risk (HR, 1.46).

Conclusions:

• Concurrent surgical LAAO during cardiac surgery is associated with reduced risks of subsequent stroke and all-cause mortality.
• Further research, including randomized clinical trials, is necessary to definitively establish the role of surgical LAAO.