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Published on: February 28, 2012
Heart failure after left atrial appendage occlusion: Insights from the LAAOS III randomized trial
Philipp Krisai1, Emilie P Belley-Cote2,3,4, William F McIntyre2,3,4
1Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland.
Insights
Left atrial appendage occlusion or removal (LAAO) during cardiac surgery did not significantly change the risk of heart failure (HF) hospitalizations or death. This finding suggests LAAO is safe regarding HF outcomes in patients undergoing surgery.
Area of Science:
- Cardiology
- Cardiac Surgery
- Heart Failure Research
Background:
- The left atrial appendage (LAA) plays a role in natriuretic peptide production.
- LAA removal or occlusion (LAAO) is performed during cardiac surgery.
- Potential impact of LAAO on heart failure (HF) risk is not fully understood.
Purpose of the Study:
- To investigate the incidence of heart failure (HF) following left atrial appendage occlusion or removal (LAAO).
- To assess the composite outcome of HF-related hospitalizations and HF death in the LAAOS III trial.
- To evaluate LAAO safety concerning HF development in patients undergoing cardiac surgery.
Main Methods:
- Randomized trial (LAAOS III) involving 4811 patients with atrial fibrillation (AF) and CHA2DS2-VASc score ≥2 undergoing cardiac surgery.
- Patients were randomized to undergo surgical LAAO or not.
- HF outcomes assessed using clinical and radiographic evidence, with landmark analysis before/after 30 days and subgroup analyses.
Main Results:
- No significant difference in the composite HF outcome (hospitalizations or death) between LAAO and no LAAO groups (8.8% vs. 7.8%, HR 1.12, p=0.25).
- HF incidence was similar in both groups during the first 30 days and beyond.
- Consistent results observed across various subgroups, including those based on prior HF, age, sex, and ejection fraction.
Conclusions:
- Left atrial appendage occlusion or removal during cardiac surgery does not alter the risk of heart failure-related hospitalization or death.
- The findings suggest LAAO is not associated with an increased risk of heart failure in this surgical context.
- Further research may explore long-term HF implications and specific patient populations.
Aims:
The left atrial appendage (LAA) produces natriuretic peptides and its removal or occlusion might increase the risk of heart failure (HF). We aimed to investigate the incidence of HF after LAA occlusion or removal (LAAO) in the Left Atrial Appendage Occlusion Study (LAAOS III).
Methods And Results:
Patients (n = 4811) with atrial fibrillation (AF) and a CHA2DS2-VASc score ≥2, who were having cardiac surgery for another indication, were randomized to undergo surgical LAAO or not. We compared the composite outcome of HF-related hospitalizations and HF death between the two groups. HF assessment required clinical and radiographic evidence of HF. Analyses included a landmark analysis before and after 30 days and subgroups. Mean age was 71.2 years, 67.5% were male and 57.0% had prior HF. Over a mean follow-up of 3.8 years, 396 (8.3%) patients met the composite HF outcome: 209 (8.8%) with LAAO (n = 2379) and 187 (7.8%) without LAAO (n = 2391) (hazard ratio [HR] 1.12, 95% confidence interval [CI] 0.92-1.37, p = 0.25). There was no difference between the two groups in the first 30 days (1.6% vs. 1.1%; p = 0.12) and thereafter (7.6% vs. 7.1%; p = 0.57). Subgroups based on age, sex, body mass index, AF type, prior HF, cardiac rhythm or left ventricular ejection fraction showed consistent results. There was no difference in HF outcomes with LAAO between the cut-and-sew (HR 0.93, 95% CI 0.70-1.23, p = 0.62) versus other closure methods (HR 1.05, 95% CI 0.77-1.41, p = 0.77).
Conclusions:
Left atrial appendage occlusion or removal at the time of cardiac surgery does not appear to alter the risk of HF-related hospitalization or death.
Clinical Trial Registration:
ClinicalTrials.gov NCT01561651.
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