Left Atrial Appendage Closure Is Underutilized in Coronary Artery Bypass Graft Surgery

The real-world utilization and practice patterns of surgical left atrial appendage closure (s-LAAC) during coronary artery bypass graft (CABG) surgery remains inadequately characterized. This study aims to evaluate the use, predictors, and temporal trends of s-LAAC in patients undergoing isolated CABG surgery using a nationwide database.

We performed a retrospective analysis of the National Inpatient Sample from 2016 to 2021, identifying patients with a diagnosis of atrial fibrillation who underwent isolated CABG surgery. Patients were stratified by whether they received s-LAAC. Baseline characteristics, clinical outcomes, and predictors of s-LAAC utilization were analyzed.

Among 35,700 patients with atrial fibrillation undergoing isolated CABG, 4384 patients (12.3%) received s-LAAC. Utilization of s-LAAC increased significantly over time (P_trend < 0.001). Compared to those who did not receive s-LAAC, patients undergoing s-LAAC had similar in-hospital mortality (adjusted odds ratio 1.11, 95% confidence interval 0.91-1.34) and reduced cardiac bleeding (adjusted odds ratio 0.75, 95% confidence interval 0.60-0.95). Independent predictors of s-LAAC included higher Congestive heart failure, Hypertension, Age, Diabetes, Stroke (CHADS₂) score, preoperative anticoagulation, prior pacemaker placement, and treatment at a large hospital. Factors associated with lower likelihood of s-LAAC included female sex and non-White race.

Despite a rising trend in s-LAAC use during CABG surgery, the procedure remains significantly underutilized. Targeted efforts to address underrepresented patient populations are essential to achieving more equitable and broader adoption of s-LAAC in CABG.