Left Atrial Appendage Closure During Coronary Bypass Surgery in Patients on Hemodialysis

Area of Science:

• Cardiovascular Surgery
• Nephrology
• Stroke Prevention

Background:

• Patients with end-stage renal disease on hemodialysis face a persistent risk of stroke related to atrial fibrillation.
• Coronary artery bypass grafting (CABG) is a common procedure for these patients.

Purpose of the Study:

• To compare clinical outcomes in end-stage renal disease patients on hemodialysis undergoing CABG, with and without concomitant left atrial appendage (LAA) closure.
• To evaluate the impact of LAA closure on reducing death and stroke risk in this high-risk population.

Main Methods:

• A cohort of 2,783 patients undergoing isolated CABG was analyzed, with 242 having end-stage renal disease on hemodialysis and sinus rhythm.
• An inverse probability (IP)-weighted analysis was performed using propensity scores to balance baseline characteristics.
• Primary outcome was a composite of death and stroke; secondary outcomes included reoperation for bleeding, new atrial fibrillation, 30-day mortality, and heart failure readmission.

Main Results:

• Five-year stroke-free survival was significantly higher in patients who underwent LAA closure (P=0.035).
• LAA closure was associated with a reduced adjusted hazard ratio for death and stroke (0.43; P=0.023).
• Competing risk analysis confirmed LAA closure significantly reduced stroke risk (subhazard ratio 0.26; P=0.028), with no significant differences in other secondary outcomes.

Conclusions:

• Concomitant left atrial appendage closure during CABG is beneficial for end-stage renal disease patients on hemodialysis with normal sinus rhythm.
• This strategy can effectively reduce the risk of death and stroke in this vulnerable patient group.