Related Experiment Video
Updated: Aug 6, 2026
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Increasing Adoption of Left Atrial Appendage Occlusion in Isolated Coronary Artery Bypass Grafting
Alexander A Brescia1, Jordan D Groskurth2, Edward T Murphy2
1Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan.
Insights
A quality initiative successfully increased left atrial appendage occlusion (LAAO) use in atrial fibrillation patients undergoing cardiac surgery. This procedure did not add operative risk, showing promise as a quality metric.
Area of Science:
- Cardiovascular Surgery
- Medical Quality Improvement
- Interventional Cardiology
Background:
- Randomized trials indicate reduced stroke risk with Left Atrial Appendage Occlusion (LAAO) post-cardiac surgery for atrial fibrillation patients.
- This study focused on developing a quality initiative to enhance LAAO adoption rates.
Purpose of the Study:
- To implement and evaluate a statewide quality improvement initiative aimed at increasing the adoption of Left Atrial Appendage Occlusion (LAAO) in eligible cardiac surgery patients.
- To assess the impact of the quality initiative on LAAO utilization rates and patient outcomes.
Main Methods:
- A statewide collaborative involving 33 hospitals targeted patients undergoing isolated coronary artery bypass grafting (CABG) with atrial fibrillation.
- An interrupted time series analysis compared LAAO rates before (Jan 2019-Dec 2019) and after (Jan 2020-Mar 2021) the quality initiative implementation.
- Patient characteristics, procedural data, and clinical outcomes were compared between patients who did and did not undergo concomitant LAAO.
Main Results:
- The LAAO rate significantly increased from 61% to 79% post-initiative (P < .001).
- Patients undergoing LAAO were older and more frequently male, with similar CHA2DS2-VASc scores but lower predicted mortality risk compared to those without LAAO.
- Concomitant LAAO added minimal procedural time and did not increase operative mortality, major morbidity, or thromboembolic events.
Conclusions:
- Left Atrial Appendage Occlusion (LAAO) can be safely performed in conjunction with isolated coronary artery bypass grafting (CABG) without increasing operative risk.
- A statewide quality improvement initiative effectively boosted the rate of concomitant LAAO in atrial fibrillation patients undergoing CABG.
- The findings support the evaluation of LAAO as a potential quality metric in cardiac surgery.
Background:
Recent randomized trial data showed fewer strokes with left atrial appendage occlusion (LAAO) after cardiac surgery in patients with atrial fibrillation. This study developed a quality initiative to increase LAAO adoption.
Methods:
Among 11,099 patients who underwent isolated coronary artery bypass grafting (CABG) between January 2019 and March 2021 at 33 hospitals in Michigan, those patients with atrial fibrillation who underwent first-time, on-pump CABG were eligible (n = 1241). A goal LAAO rate of 75% was selected as a quality improvement target through a statewide collaborative. An interrupted time series analysis evaluated the change in LAAO rate before implementation (January to December 2019) vs after implementation (January 2020 to March 2021).
Results:
Implementation of the quality metric improved the LAAO rate from 61% (357 of 581) before implementation to 79% (520 of 660) after implementation (P < .001). Compared with patients who did not undergo concomitant LAAO, patients who underwent LAAO (71%; 877 of 1241) were older, more frequently male, and had a lower The Society of Thoracic Surgeons Predicted Risk of Mortality score (2.9% ± 3.5% vs 3.7% ± 5.7%; P = .003), whereas other baseline characteristics, including CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke or transient ischemic attack, vascular disease, age 65-74 years, female sex category) scores, were similar. Mean bypass and cross-clamp times were 7 and 6 minutes longer, respectively, in the LAAO group among patients who did not undergo concomitant ablation. Operative mortality, major morbidity, blood product administration, and thromboembolic events were similar between the groups. Interrupted time series analysis showed a significant increase in LAAO rate after implementation (P = .009).
Conclusions:
LAAO in patients with atrial fibrillation who underwent isolated CABG did not add operative risk vs isolated CABG without LAAO. A statewide quality improvement initiative was successful in increasing the rate of concomitant LAAO and could be further evaluated as a potential quality metric in cardiac surgery.
More Related Videos
28:13Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
13:10Direct Re-implantation of Left Coronary Artery into the Aorta in Adults with Anomalous Origin of Left Coronary Artery from the Pulmonary Artery ALCAPA
Published on: April 24, 2017
Related Concept Videos
01:24Cardiac Catheterization III: Left Heart Catheterization
01:29Cardiomyopathy V: Interprofessional Care