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The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Perioperative outcome of left atrial appendage amputation in coronary artery bypass grafting
Mustafa Gerçek1, Tomislav Skuljevic1, Jochen Börgermann1
1Clinic for Cardiac Surgery and Pediatric Cardiac Surgery, Heart Center Duisburg, Gerrickstraße 21, 47137, Duisburg, Germany.
Insights
Left atrial appendage (LAA) amputation during cardiac surgery is safe. This procedure, when performed with coronary artery bypass grafting (CABG), showed no increase in stroke, mortality, or reoperation rates.
Area of Science:
- Cardiology
- Cardiac Surgery
- Vascular Surgery
Background:
- Left atrial appendage (LAA) amputation is increasingly used with cardiac surgery to reduce stroke risk in atrial fibrillation patients.
- Rising recommendations for LAA amputation necessitate robust data on its perioperative safety.
Purpose of the Study:
- To evaluate the perioperative safety of concomitant Left Atrial Appendage (LAA) amputation during coronary artery bypass grafting (CABG).
Main Methods:
- Retrospective study of 3904 patients undergoing isolated CABG (2018-2021) at two high-volume centers.
- Patients were divided into CABG and CABG + LAA amputation groups.
- Propensity score matching (PS matching) was used to ensure group comparability, with 856 patients in each group post-matching.
Main Results:
- No significant difference in the primary composite endpoint (all-cause mortality, stroke, reoperation) between CABG and CABG + LAA groups (7.0% vs. 6.5%, p=0.70).
- Individual components of the composite endpoint, including mortality (p=0.84), stroke (p=0.74), and reoperation (p=0.50), showed no significant differences.
- Subgroup analyses did not reveal any significant dissimilarities.
Conclusions:
- Concomitant LAA amputation during CABG is not associated with adverse in-hospital outcomes.
- The procedure appears safe concerning mortality, stroke, and reoperation rates.
Background:
Left atrial appendage (LAA) amputation performed alongside cardiac surgery has become an increasingly established procedure to reduce stroke risk in patients with atrial fibrillation. As the recommendation levels for LAA amputation continue to rise, ample evidence assessing its perioperative safety and risk factors is of utmost interest.
Methods:
All patients who underwent isolated coronary artery bypass grafting (CABG) between 2018 and 2021 at two high-volume centers were retrospectively included in the study. Patients were divided into two groups-the CABG and CABG + LAA groups-based on whether they underwent concomitant LAA amputation. Propensity score matching (PS matching) was applied to ensure comparability between the groups. The primary endpoint was defined as a composite outcome comprising of all-cause mortality, stroke, and reoperation. Secondary endpoints included the components of the primary endpoint, perioperative outcome parameters, transfusion rates, and laboratory parameters.
Results:
A total of 3904 patients were included with 3038 and 866 in the CABG and CABG + LAA group, respectively. After PS matching each group consisted of 856 patients. The primary endpoint showed no significant differences between the CABG and CABG + LAA group (7.0% vs. 6.5% (OR 0.9 95% CI [0.64; 1.35], p = 0.70)). Similarly, there were no notable differences in the individual components of the composite endpoint: all-cause mortality (p = 0.84), stroke (p = 0.74), and reoperation (p = 0.50). Subgroup results did not show any relevant dissimilarity.
Conclusion:
The concomitant performance of LAA amputation is not associated with worse in-hospital outcomes, as measured by the composite endpoint of all-cause mortality, stroke, and reoperation.
