Left Atrial Appendage Amputation for Atrial Fibrillation during Aortic Valve Replacement

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Thromboembolic Disease Research

Background:

• Left atrial appendage (LAA) occlusion is known to reduce stroke risk in patients with atrial fibrillation (AF).
• Current guidelines offer only a soft recommendation ('may be considered') for LAA occlusion during cardiac surgery.
• Patients with AF and aortic stenosis undergoing biological aortic valve replacement (AVR) face a high thromboembolic risk.

Purpose of the Study:

• To evaluate the effectiveness of LAA amputation in reducing thromboembolic risk.
• To assess the safety and impact of LAA amputation in patients undergoing biological AVR for aortic stenosis and AF.

Main Methods:

• Retrospective analysis of two patient cohorts undergoing biological AVR: one with LAA amputation and one without.
• Patients were matched based on baseline characteristics.
• Data collection included hospital records, with follow-up via telephone or in-person interviews to assess 30-day and long-term outcomes.

Main Results:

• LAA amputation was associated with a significantly lower incidence of cumulative and late ischemic stroke (6.4% vs. 25%, p=0.028 and 3.2% vs. 20%, p=0.008, respectively).
• No significant differences were found in postoperative stroke, re-exploration for bleeding, late pericardial effusion, in-hospital mortality, or all-cause mortality between the groups.
• The study included 157 patients, with 74 matched pairs analyzed for outcomes over a median follow-up of 45-48 months.

Conclusions:

• Concomitant LAA amputation during biological AVR in patients with AF and aortic stenosis significantly reduces ischemic stroke risk.
• LAA amputation does not introduce additional periprocedural risks, enhancing the clinical benefits of AVR.
• Omitting LAA amputation in minimally invasive procedures for this patient population is discouraged to maximize patient outcomes.