Key result
Concomitant surgical left atrial appendage occlusion during mitral valve surgery in patients with atrial fibrillation and severe mitral regurgitation significantly reduced the composite of all-cause death and thromboembolic events (HR 0.30).
Why the study?
Data on the clinical significance of left atrial appendage occlusion in patients with mitral regurgitation were lacking.
Does concomitant surgical left atrial appendage occlusion reduce the composite of all-cause death and thromboembolic events in patients with atrial fibrillation and chronic severe mitral regurgitation undergoing mitral valve surgery?
Cohort (n=237)
No
Does concomitant surgical left atrial appendage occlusion reduce the composite of all-cause death and thromboembolic events in patients with atrial fibrillation and chronic severe mitral regurgitation undergoing mitral valve surgery?
Hazard Ratio: 0.3 (95% CI 0.1–0.91)
p-value: p=0.033
Concomitant LAAO was associated with fewer composite events in AF patients with severe MR; hypothesis-generating and needs prospective confirmation before practice change.
Surgical occlusion of the left atrial appendage (LAA) during cardiac surgery in patients with atrial fibrillation (AF) is known to reduce thromboembolism. However, data on the clinical significance of LAA occlusion (LAAO) in patients with mitral regurgitation (MR) are lacking. A total of 237 AF patients with chronic severe MR who underwent mitral valve (MV) surgery were retrospectively analyzed. Patients were divided into two groups according to concomitant LAAO or LAA preservation. The primary outcome was a composite of all-cause death and thromboembolic events (ischemic stroke or systemic embolism). The LAA was surgically occluded in 98 (41%) patients and preserved in 139 (59%) patients. During the follow-up period (median, 37 months), 29 primary outcomes occurred. In the Kaplan–Meyer analysis, the LAA preservation group showed a greater cumulative incidence of the primary outcome ( P = 0.002) and thromboembolic events ( P = 0.003) than the LAAO group. In the univariate Cox regression analysis, coronary artery disease, CHA 2 DS 2 -VASc score, a cauliflower-shaped LAA, Maze, and no LAAO were significantly associated with the primary outcome. In the multivariate Cox regression analysis, concomitant LAAO was significantly linked to the primary outcome (hazard ratio [HR]: 0.30, 95% confidence interval [CI]: 0.10–0.91, P = 0.033) and thromboembolic events (HR: 0.19, 95% CI: 0.04–0.87, P = 0.032). These benefits from LAAO were consistent, even after propensity score–matched analysis. For patients undergoing surgery for chronic MR who also have AF, concomitant surgical LAAO is associated with favorable clinical outcome.
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Seo et al. (2024) conducted a cohort in Atrial fibrillation with chronic severe mitral regurgitation (n=237). Concomitant surgical left atrial appendage occlusion (LAAO) vs. Left atrial appendage preservation was evaluated on Composite of all-cause death and thromboembolic events (ischemic stroke or systemic embolism) (HR 0.30, 95% CI 0.10-0.91, p=0.033). Concomitant surgical left atrial appendage occlusion during mitral valve surgery in patients with atrial fibrillation and severe mitral regurgitation significantly reduced the composite of all-cause death and thromboembolic events (HR 0.30).
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