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The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Concomitant left atrial appendage closure during left ventricular assist device surgery can reduce ischaemic
Hidefumi Nishida1, Valluvan Jeevanandam1, Christopher Salerno1
1Department of Surgery, University of Chicago Medicine, Chicago, IL, USA.
Insights
Left atrial appendage closure (LAAC) during left ventricular assist device (LVAD) surgery significantly reduces ischemic stroke risk. This procedure does not increase perioperative mortality or complications, offering a safer option for patients.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Neurology
Background:
- Left ventricular assist device (LVAD) implantation is a critical intervention for advanced heart failure.
- Ischemic cerebrovascular accidents (strokes) are a significant complication following LVAD surgery.
- The role of concomitant left atrial appendage closure (LAAC) in mitigating stroke risk during LVAD procedures is not well-established.
Purpose of the Study:
- To investigate the efficacy of performing left atrial appendage closure (LAAC) concurrently with left ventricular assist device (LVAD) surgery in reducing the incidence of ischemic cerebrovascular accidents.
- To assess the impact of concomitant LAAC on perioperative mortality and complications in LVAD patients.
Main Methods:
- A retrospective study included 310 patients undergoing LVAD surgery (HeartMate II or 3) between January 2012 and November 2021.
- Patients were divided into two groups: those who underwent concomitant LAAC (Group A, n=98) and those who did not (Group B, n=212).
- Clinical outcomes, focusing on the incidence of cerebrovascular accidents, were compared between the two groups using statistical analysis, including multivariable competing risk analysis.
Main Results:
- No significant differences in baseline characteristics (age, CHADS2 score, atrial fibrillation history) or in-hospital mortality were observed between Group A and Group B.
- The cumulative incidence of ischemic cerebrovascular accidents was significantly lower in Group A (5.3% at 36 months) compared to Group B (16.8% at 36 months) (P=0.017).
- Multivariable analysis revealed that LAAC was independently associated with a reduced risk of ischemic cerebrovascular accidents (HR 0.38, P=0.043).
Conclusions:
- Concomitant left atrial appendage closure (LAAC) during left ventricular assist device (LVAD) surgery is an effective strategy for reducing the incidence of ischemic cerebrovascular accidents.
- Performing LAAC alongside LVAD implantation does not appear to increase perioperative mortality or complications.
- These findings suggest that LAAC should be considered as a potentially beneficial adjunct procedure in patients undergoing LVAD surgery.
Objectives:
It remains unknown if the left atrial appendage closure (LAAC) at the time of left ventricular assist device (LVAD) surgery can reduce ischaemic cerebrovascular accidents.
Methods:
Consecutive 310 patients who underwent LVAD surgery with HeartMate II or 3 between January 2012 and November 2021 were included in this study. The cohort was divided into 2 groups: patients with LAAC (group A) and without LAAC (group B). We compared the clinical outcomes including the incidence of cerebrovascular accident between 2 groups.
Results:
Ninety-eight patients were included in group A, and 212 patients in group B. There were no significant differences between 2 groups in age, preoperative CHADS2 score and history of atrial fibrillation. In-hospital mortality did not differ significantly between the 2 groups (group A: 7.1%, group B: 12.3%, P = 0.16). Thirty-seven patients (11.9%) experienced ischaemic cerebrovascular accident (5 patients in group A and 32 patients in group B). The cumulative incidence from ischaemic cerebrovascular accidents in group A (5.3% at 12 months and 5.3% at 36 months) was significantly lower than that in group B (8.2% at 12 months and 16.8% at 36 months; P = 0.017). In a multivariable competing risk analysis, LAAC was associated with reducing ischaemic cerebrovascular accidents (hazard ratio 0.38, 95% confidence interval 0.15-0.97, P = 0.043).
Conclusions:
Concomitant LAAC in LVAD surgery can reduce ischaemic cerebrovascular accidents without increasing perioperative mortality and complications.
