C-49 | Concomitant Left Atrial Appendage Exclusion during Cardiac Surgery for patients without a diagnosis of Atrial Fibrillation: A NATIONWIDE ANALYSIS

Left atrial appendage exclusion (LAAE) is an effective means for reducing stroke risk in patients with atrial fibrillation undergoing cardiac surgery. However, at times, based on institutional practices, it is performed on patients without a diagnosis of atrial fibrillation. We sought to evaluate the outcomes of patients who underwent concomitant LAAE without a diagnosis of atrial fibrillation. We used the 2016-2020 National Inpatient Sample database to identify hospitalizations for cardiac surgery and to compare the outcomes in those with and without concomitant LAAE who did not have a diagnosis of atrial fibrillation. We utilized the weighted data to compare the incidence of inpatient mortality and rates of complications such as stroke, bleeding, infection, and heart failure. From 2016 to 2020, 745,034 patients underwent cardiac surgery who did not have a diagnosis of atrial fibrillation, of which 33,505 (4.5%) had concomitant surgical LAAE. Patients undergoing concomitant LAAE with cardiac surgery had similar inpatient mortality (adjusted Odds ratio (aOR) 0 .96, p =0.624), stroke risk (aOR 0 .88, p= 0.105), risk of bleeding (aOR 1.27, p= 0.164), and infectious complication (aOR 0.78, p =0.343). However, at the same time, the LAAE group had higher pericardial complications (aOR 1.21, p = 0.007), higher heart failure exacerbations (aOR 1.13, p = 0.005), longer length of stay (mean difference 0.33 days, p = 0.006) and higher total hospital charges (mean difference $43,001, p <0.001). The overall frequency of concomitant LAAE increased yearly from 1.9% in 2016 to 7.2% in 2020 (ptrend <0.001). However, when a subgroup analysis was performed for those with a high Chad VaSc score >3, the odds of stroke were lower in the LAAE group (aOR 0.84, p = 0.047). Patients undergoing concomitant LAAE without a diagnosis of atrial fibrillation have worse outcomes then those without LAAE. However, patients with a high Chad VaSc score >3 may benefit from concomitant LAAE; further studies are needed to confirm these findings and identify subgroups that may benefit from prophylactic LAAE.