Key result
Left atrial appendage preservation during the maze procedure improved left atrial mechanical contraction (72.7% vs 48.6%) without significantly increasing stroke risk compared to occlusion.
Why the study?
The LAA contributes significantly to LA mechanical contraction, but the preventive effect of LAA occlusion during the maze procedure against cerebral infarction remains controversial.
Does left atrial appendage preservation improve LA mechanical contraction and prevent stroke compared to occlusion in patients undergoing the maze procedure?
Cohort (n=188)
No
Does left atrial appendage preservation improve LA mechanical contraction and prevent stroke compared to occlusion in patients undergoing the maze procedure?
Preserving the left atrial appendage during the maze procedure may safely improve left atrial mechanical function without increasing the risk of stroke compared to LAA occlusion.
BACKGROUND AND OBJECTIVES: The left atrial appendage (LAA) can contribute significantly to LA mechanical contraction. Nevertheless, the preventive effect of LAA occlusion during the maze procedure against cerebral infarction remains controversial. In this study, we compared the surgical, cardiac hemodynamic, and neurologic outcomes between LAA preservation and occlusion performed during the maze procedure. METHODS: Between January 2015 and August 2021, 252 patients underwent the maze procedure using cryoablation at our medical center. After excluding patients according to our exclusion criteria (i.e., mechanical prosthesis implantation, preexisting LAA thrombus), LAA was preserved in 113 patients (non-occlusion group) and occluded in 75 patients (occlusion group). Outcomes were compared using propensity score matching (PSM). RESULTS: PSM did not reveal significant intergroup differences in baseline characteristics between the non-occlusion (n=53) and occlusion (n=53) groups. During a median follow-up of 44 months, 2 patients in the non-occlusion group (3.8%) experienced ischemic strokes. There was no significant difference in the rate of freedom from stroke (p=0.19) and major adverse cardiac events (p=0.43) between the 2 groups. Through echocardiography at 1-year follow-up, a statistically significant difference in LA mechanical contraction was observed between the non-occlusion group and occlusion group (24 of 33 [72.7%] vs. 18 of 37 [48.6%], respectively; p=0.04). CONCLUSIONS: In this study, preservation of the LAA during the maze procedure resulted in better LA function than LAA occlusion, with similar rates of stroke.
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Song et al. (2023) conducted a cohort in Atrial fibrillation undergoing maze procedure (n=188). Left atrial appendage preservation vs. Left atrial appendage occlusion was evaluated on Freedom from stroke (p=0.19). Left atrial appendage preservation during the maze procedure improved left atrial mechanical contraction (72.7% vs 48.6%) without significantly increasing stroke risk compared to occlusion.
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