Key result
Surgical LAAO during mechanical heart valve replacement shows no association with fewer major events.
Why the study?
Evidence regarding the effectiveness of surgical left atrial appendage occlusion (SLAAO) in patients with atrial fibrillation undergoing mechanical heart valve replacement (MHVR) is lacking.
Does surgical left atrial appendage occlusion reduce ischemic stroke, systemic embolism, and all-cause mortality in patients with atrial fibrillation undergoing mechanical heart valve replacement?
Cohort (n=497)
Does surgical left atrial appendage occlusion reduce ischemic stroke, systemic embolism, and all-cause mortality in patients with atrial fibrillation undergoing mechanical heart valve replacement?
p-value: p=0.830
Concomitant surgical left atrial appendage occlusion during mechanical heart valve replacement in patients with atrial fibrillation does not provide additional protection against thromboembolic events or mortality but increases procedural times and length of stay.
SLAAO during mechanical valve replacement was not associated with fewer events; leaves open whether RCTs would demonstrate benefit.
BACKGROUND: Surgical left atrial appendage occlusion (SLAAO) may be associated with a lower risk of thromboembolism in patients with atrial fibrillation undergoing cardiac surgery. However, evidence regarding the effectiveness of SLAAO in patients undergoing mechanical heart valve replacement (MHVR) is lacking. Therefore, we aimed to evaluate the association between SLAAO and the cardiovascular outcomes in patients with atrial fibrillation undergoing MHVR. METHODS: We retrospectively analyzed data for 497 patients with atrial fibrillation; 27.6% of the patients underwent SLAAO, and the remainder of the patients did not (No-SLAAO group). The primary outcome was a composite of ischemic stroke, systemic embolism, and all-cause mortality. Cumulative event-free survival rates were estimated using Kaplan-Meier curves, and we performed multivariate Cox analyses to evaluate the association between SLAAO and outcomes. We used one-to-one propensity score matching to balance patients' baseline characteristics, and analyzed 120 matching pairs. RESULTS: Five patients died within 30 days postoperatively, and there were no significant differences between the two groups regarding in-hospital complications (all P > 0.05). After a median follow-up of 14 months, 14 primary events occurred. Kaplan-Meier curves showed no difference in the cumulative incidence of freedom from the primary outcome (log-rank P = 0.830), hemorrhagic events (log-rank P = 0.870), and the secondary outcome (log-rank P = 0.730), between the two groups. Multivariable Cox proportional hazards regression analysis showed no association between SLAAO and any outcome (all P > 0.05). After propensity score matching, cardiopulmonary bypass time and aortic cross-clamp time, and the postoperative length of stay were significantly longer in the SLAAO group (all P < 0.05); results were similar to the unadjusted analyses. CONCLUSIONS: Concomitant SLAAO and MHVR was associated with longer length of stay, and cardiopulmonary bypass time and aortic cross-clamp time, but was not associated with additional protective effects against thromboembolic events and mortality during the 14-month follow-up.
No takes yet. Share an insight, caveat, or question.
Zheng et al. (2020) conducted a cohort in Atrial fibrillation undergoing mechanical heart valve replacement (n=497). Surgical left atrial appendage occlusion (SLAAO) vs. No-SLAAO was evaluated on Composite of ischemic stroke, systemic embolism, and all-cause mortality (p=0.830). Surgical left atrial appendage occlusion during mechanical heart valve replacement was not associated with reduced ischemic stroke, systemic embolism, or mortality (log-rank P=0.830).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: