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Published on: February 26, 2013
Outcomes After Left Atrial Appendage Clip Placement During Cardiac Surgery: A Nationwide Analysis
Jean-Luc A Maigrot1, Aaron J Weiss1, Guangjin Zhou2
1Department of Thoracic and Cardiovascular Surgery, Kaufman Center for Heart Failure Treatment and Recovery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio.
Insights
Adding a left atrial appendage clip (LAAC) during cardiac surgery did not increase mortality or complications. However, it was linked to more 30-day readmissions but a lower stroke incidence.
Area of Science:
- Cardiology
- Cardiac Surgery
- Health Outcomes Research
Background:
- Left atrial appendage clip (LAAC) placement is an emerging strategy during cardiac surgery.
- Its impact on postoperative outcomes, particularly when performed concomitantly without surgical ablation, requires thorough investigation.
Purpose of the Study:
- To evaluate the nationwide associations between concomitant LAAC placement during cardiac surgery and postoperative outcomes.
- To compare mortality, complications, and readmissions between patients with and without LAAC during index admissions and early follow-up.
Main Methods:
- Retrospective analysis of 1,260,999 patients undergoing cardiac surgery (2016-2020) from the Nationwide Readmissions Database.
- Stratification based on concomitant LAAC placement versus no LAAC, excluding patients who underwent surgical ablation.
- Propensity score matching was utilized to compare outcomes during index admissions and 30/90-day readmissions.
Main Results:
- Concomitant LAAC placement (6.7% of cohort) was not associated with increased index admission mortality or overall complications after propensity score matching.
- LAAC was linked to higher 30-day readmissions (15% vs. 13%), but showed a lower incidence of stroke (5.3% vs. 6.5%) and higher heart failure (35% vs. 30%).
- Similar trends were observed for 90-day readmissions, with no significant differences in mortality or overall complications.
Conclusions:
- Concomitant LAAC placement during cardiac surgery is associated with a lower early postdischarge incidence of stroke.
- The practice demonstrates a favorable short-term risk-benefit profile in a real-world population.
- Further long-term studies with granular data are warranted to fully assess the benefits of this approach.
Abstract:
This study evaluated the nationwide associations between concomitant left atrial appendage clip (LAAC) placement during cardiac surgery and postoperative outcomes. We identified 1,260,999 patients who underwent coronary artery bypass grafting, valve, and aortic surgeries in the 2016 to 2020 Nationwide Readmissions Database and stratified by concomitant LAAC versus no LAAC placement. Patients who underwent surgical ablation were excluded. Mortality and complications were compared during index admissions and for patients readmitted within 30 and 90 days of the index discharge date for unmatched and propensity score-matched groups. Overall, 6.7% (84,293) of patients underwent cardiac surgery and concomitant LAAC placement without surgical ablation. After propensity score matching, the index admission mortality and overall complications were not different in patients with LAAC versus patients without LAAC. LAAC placement was associated with increased any-cause 30-day readmissions (15% vs 13%, p <0.01). In patients with LAAC, within 30 days, there were no differences in mortality (3.9% vs 3.8%, p = 0.60) or overall complications (64% vs 63%, p = 0.20), whereas stroke was lower (5.3% vs 6.5%, p <0.01) and heart failure was higher (35% vs 30%, p <0.01). For patients readmitted within 90 days, similar findings were observed for any-cause readmissions, mortality, overall complications, stroke, and heart failure. In conclusion, concomitant LAAC placement during cardiac surgery was associated with lower early postdischarge incidence of stroke and a favorable overall risk-benefit profile. Given these short-term findings in a real-world population of all patients who underwent cardiac surgery, longer-term studies with more granular data are needed to evaluate the potential benefit of this practice.
