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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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Left atrial appendage exclusion is effective in reducing postoperative stroke after mitral valve replacement

Shengli Jiang1, Huajun Zhang1,2, Shixiong Wei1,2

  • 1Department of Cardiovascular Surgery, Chinese PLA General Hospital, Beijing, China.

Journal of Cardiac Surgery
|September 17, 2020
PubMed

Insights

Surgical exclusion of the left atrial appendage (LAA) during mitral valve replacement (MVR) significantly reduces the risk of postoperative ischemic stroke, especially in patients with atrial fibrillation (AF). This safe and effective procedure enhances patient outcomes.

Area of Science:

  • Cardiovascular Surgery
  • Interventional Cardiology
  • Stroke Prevention

Background:

  • Mitral valve replacement (MVR) is a critical procedure for managing severe mitral valve disease.
  • Postoperative stroke remains a significant complication following MVR, particularly in patients with atrial fibrillation (AF).
  • The left atrial appendage (LAA) is a common source of thrombus formation, contributing to embolic events.

Purpose of the Study:

  • To evaluate the efficacy of surgical left atrial appendage (LAA) exclusion in preventing ischemic stroke after mitral valve replacement (MVR).
  • To assess the safety and impact of concurrent LAA exclusion during MVR on early postoperative stroke incidence.
  • To determine if LAA exclusion offers differential benefits in patients with and without atrial fibrillation (AF).

Main Methods:

  • Retrospective review of 860 patients undergoing MVR between January 2008 and January 2013.
  • Patients were randomly assigned to either LAA exclusion (n=521) or LAA nonexclusion (n=339) groups.
  • LAA exclusion involved suturing the LAA neck, while the nonexclusion group left the LAA intact; mural thrombus was removed in all cases.

Main Results:

  • The incidence of early postoperative ischemic stroke was significantly lower in the LAA exclusion group (0.6%) compared to the nonexclusion group (2.7%) (p=0.011).
  • Multivariate analysis revealed LAA exclusion significantly reduced stroke risk in patients with AF (OR=0.070, p=0.025).
  • No significant difference in stroke risk reduction was observed in patients without AF (OR=1.902, p=0.601), and no differences in mortality or major complications were noted between groups.

Conclusions:

  • Concurrent surgical LAA exclusion during MVR is a safe and effective strategy for reducing postoperative ischemic stroke.
  • The benefit of LAA exclusion is particularly pronounced in patients with a history of atrial fibrillation (AF).
  • This surgical approach offers a valuable method for stroke risk mitigation in the context of MVR.
Abstract

Keywords:
atrial fibrillationleft atrial appendage closuremitral valve replacementstroke

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