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Updated: Jul 31, 2026
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Prophylactic left atrial appendage ligation during coronary artery bypass grafting: A propensity score-matched
Sean W W Noona1, Steven D Young1, Matthew P Weber1
1Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Va.
Insights
Prophylactic left atrial appendage ligation during coronary artery bypass grafting did not improve short-term clinical outcomes like stroke or mortality. However, it increased postoperative atrial fibrillation, anticoagulation use, and costs.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Medical Devices
Background:
- Atrial fibrillation is a common complication after cardiac surgery.
- Left atrial appendage ligation is a strategy to prevent stroke.
- Its role in patients without preoperative atrial fibrillation undergoing coronary artery bypass grafting is unclear.
Purpose of the Study:
- To evaluate short-term outcomes of prophylactic left atrial appendage ligation.
- To assess statewide practice patterns of this procedure.
- To compare outcomes in patients undergoing coronary artery bypass grafting without preoperative atrial fibrillation.
Main Methods:
- Adult patients undergoing on-pump coronary artery bypass grafting (2017-2023) were identified.
- Patients with prior atrial fibrillation or cardiac surgery were excluded.
- Propensity score matching was used to compare ligation versus no ligation groups.
Main Results:
- Prophylactic left atrial appendage ligation was associated with longer crossclamp time, ICU hours, and length of stay.
- Increased rates of postoperative atrial fibrillation and discharge on anticoagulation were observed.
- No significant differences in stroke, readmission, or operative mortality were found.
Conclusions:
- Prophylactic left atrial appendage ligation during coronary artery bypass grafting did not improve short-term clinical outcomes.
- Higher rates of postoperative atrial fibrillation and increased costs were noted.
- Further research is needed to clarify the indications and long-term efficacy.
Objective:
The study objective was to evaluate short-term outcomes and statewide practice patterns of prophylactic left atrial appendage ligation in patients undergoing coronary artery bypass grafting without preoperative atrial fibrillation.
Methods:
Adult patients who underwent on-pump coronary artery bypass grafting (2017-2023) within a regional collaborative were identified. Patients with a history of atrial fibrillation, previous cardiac surgery, or nondevice-based left atrial appendage ligation were excluded. Patients were stratified by left atrial appendage ligation status and were propensity score matched. Univariable analysis was used to compare short-term clinical outcomes.
Results:
Of 16,547 patients examined, 442 underwent prophylactic left atrial appendage ligation. The propensity score-matched cohort (439 in the prophylactic left atrial appendage ligation group, 439 in the no prophylactic left atrial appendage ligation group) was compared and had no significant differences in preoperative Congestive heart failure, Hypertension, Age ≥ 75 (doubled), Diabetes mellitus, prior Stroke, Transient ischemic attack or Thromboembolism (doubled), Vascular disease, Age 65 to 74, Sex category (female)(CHA2DS2-VASc) scores or operative variables. The prophylactic left atrial appendage ligation group had longer crossclamp time (82 vs 76 minutes, P = .001), intensive care unit hours (72 vs 66, P = .001), and length of stay (6.0 vs 6.0 days, P = .010); increased postoperative atrial fibrillation (35% vs 24%, P < .001); and more discharges on anticoagulation (17% vs 8.2%, P < .001). There were no significant differences in postoperative stroke (1.1% vs 2.1%, P = .423), readmission (13% vs 9.6%, P = .118), operative mortality (2.5% vs 1.6%, P = .480), or readmission for thrombotic or bleeding complications (0.7% vs 1.1%, P = .724). Hospitalization costs were significantly higher for the prophylactic left atrial appendage ligation group ($43,478 vs $40,645, P < .001). The rate of prophylactic left atrial appendage ligation during coronary artery bypass grafting increased from 1.61% (2017) to 5.65% (2023) (P < .001).
Conclusions:
Despite higher rates of postoperative atrial fibrillation, discharge on anticoagulation, and hospitalization costs in patients undergoing prophylactic left atrial appendage ligation during coronary artery bypass grafting, there was no difference in short-term clinical end points including stroke and operative mortality.
