Surgical strategy for atrial fibrillation to prevent stroke in patients undergoing cardiac surgery

Area of Science:

• Cardiovascular Surgery
• Electrophysiology
• Cardiac Arrhythmias

Background:

• Atrial fibrillation (AF) management during cardiovascular surgery often involves concomitant procedures.
• The full maze procedure and left atrial appendage closure (LAAc) are options for AF treatment in these patients.
• Comparing the long-term efficacy and safety of these concomitant procedures is crucial for clinical decision-making.

Purpose of the Study:

• To compare the outcomes of the full maze procedure versus LAAc as concomitant procedures for atrial fibrillation in patients undergoing cardiovascular surgery.
• To evaluate operative mortality, freedom from cardiac-related death, thromboembolic stroke, and heart failure between the two groups.

Main Methods:

• A retrospective study of 151 patients undergoing concomitant AF surgery and cardiovascular surgery between April 2005 and December 2019.
• Patients were divided into a maze group (n=87) and an LAAc group (n=63).
• Mean follow-up was 5.2 ± 3.8 years, analyzing outcomes including mortality, stroke, and heart failure.

Main Results:

• The LAAc group had significantly higher operative mortality, older age, and more comorbidities.
• No significant difference was observed in freedom from cardiac-related death or 5-year freedom from thromboembolic stroke between the groups.
• The 5-year freedom from heart failure was significantly higher in the maze group (100%) compared to the LAAc group (86%).

Conclusions:

• The maze procedure demonstrated favorable operative and long-term results, particularly in preventing heart failure, and should be considered when indicated.
• Concomitant LAAc may be a viable option for stroke prevention in AF patients unsuitable for the maze procedure.
• These findings support individualized treatment strategies based on patient profiles and procedural indications.