Impact of Left Atrial Appendage Exclusion on Short-Term Outcomes in Isolated Coronary Artery Bypass Graft Surgery
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Published on: February 28, 2012
Eitezaz Mahmood1,2, Robina Matyal3, Feroze Mahmood3
1Departments of Cardiothoracic Surgery (E.M., K.K.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Insights
Left atrial appendage exclusion during bypass surgery increases 30-day readmissions for atrial fibrillation patients. Further research is needed to mitigate adverse effects and improve patient outcomes.
Area of Science:
- Cardiology
- Cardiac Surgery
- Health Services Research
Background:
- Atrial fibrillation is a common condition often treated with left atrial appendage (LAA) exclusion.
- Coronary artery bypass graft (CABG) surgery is frequently performed in patients with atrial fibrillation.
- The impact of LAA exclusion on outcomes in patients undergoing isolated CABG surgery requires further investigation.
Purpose of the Study:
- To evaluate the short-term outcomes of left atrial appendage (LAA) exclusion in patients with atrial fibrillation undergoing isolated coronary artery bypass graft (CABG) surgery.
- To determine the association between LAA exclusion and 30-day readmissions, in-hospital mortality, and stroke after CABG surgery.
Main Methods:
- Utilized the 2010-2014 National Readmissions Database, including patients with atrial fibrillation undergoing isolated CABG.
- Identified patients with and without LAA ligation using specific ICD-9-CM procedure codes.
- Employed multivariate logistic regression to analyze 30-day readmissions, in-hospital mortality, and stroke, adjusting for covariates.
Main Results:
- Analyzed 253,287 patients; 7.0% underwent LAA closure.
- LAA exclusion was linked to increased risks of respiratory failure and acute kidney injury.
- LAA exclusion did not significantly alter stroke rates or in-hospital mortality but was associated with a higher risk of 30-day readmission (16.0% vs. 9.6%).
Conclusions:
- Left atrial appendage exclusion during isolated CABG in atrial fibrillation patients is associated with increased 30-day readmission rates.
- The procedure may lead to adverse outcomes such as respiratory failure and acute kidney injury.
- Further research into mitigating the loss of LAA hormonal and hemodynamic effects is recommended to enhance therapeutic benefits.
Background:
The objective of this study was to evaluate the impact of left atrial appendage (LAA) exclusion on short-term outcomes in patients with atrial fibrillation undergoing isolated coronary artery bypass graft surgery.
Methods:
We queried the 2010 to 2014 National Readmissions Database for patients who underwent coronary artery bypass graft repair with and without LAA ligation by using International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes (International Classification of Diseases, Ninth Revision, Clinical Modification: 36.1xx). Only patients with a history of atrial fibrillation were included in our analysis. The primary outcome of our study was 30-day readmissions following discharge. Secondary outcomes were in-hospital mortality and stroke. To assess the postoperative outcomes, we used multivariate logistic regression models to adjust for clinical and demographic covariates.
Results:
In total, we analyzed 253 287 patients undergoing coronary artery bypass graft surgery, 7.0% of whom received LAA closure. LAA exclusion was associated with a greater risk of postoperative respiratory failure (8.2% versus 6.2%, P<0.0001) and acute kidney injury (21.8% versus 18.5%, P<0.0001), but it did not significantly change the rate of blood transfusions or occurrence of cardiac tamponade. LAA exclusion was associated with a nonsignificant reduction in stroke (7.9% versus 8.6%, P=0.12), no difference in in-hospital mortality (2.2% versus 2.2% P=0.99), and a greater risk of 30-day readmission (16.0% versus 9.6%, P<0.0001). After covariate adjustment, LAA ligation remained a significant predictor of 30-day readmission (odds ratio, 1.640 [95% CI, 1.603-1.677], P<0.0001).
Conclusions:
LAA exclusion during isolated coronary artery bypass graft surgery in patients with atrial fibrillation is associated with a higher rate of 30-day readmission. Postoperative measures to mitigate the loss of the hormonal and hemodynamic effects of the LAA may increase the therapeutic benefit of this procedure.
