Increasing Adoption of Left Atrial Appendage Occlusion in Isolated Coronary Artery Bypass Grafting

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.