999 A Review of Left Atrial Appendage Occlusion for Peri-Operative Thromboembolic Risk Reduction at a Single Institution

Aim Left Atrial Appendage Occlusion for thromboembolic risk reduction in patients with AF undergoing cardiac surgery is evidence-supported. We explored our practice to understand the scale of AF burden and challenges in undertaking adequate Left Atrial Appendage occlusion therapy in cardiac surgical patients. Method This was a retrospective analysis of surgical database, hospital records, and post-op re-admission spells with AF or with acute neurological events. Results Between Jan 2019 and Jan 2023 there were n=108 (5%) re-admissions due to AF and 39 (1.8%) secondary to AF-related Stroke/TIA. Fifty-seven (n=57, 38%) of these underwent DC cardioversion. Median time to re-admission was 2 months (range: <1 month-2 years) with AF, and 4 months (range: 1 month-5 years) with neuro-thromboembolism. In a cohort of n=144 patients undergoing cardiac surgery with pre-existing AF(Paroxysmal/established), 70 patients (48.6%) underwent concomitant Left Atrial Appendage clip application (size 35mm-45mm). In non-recipients (n=74, 51%); emergency/urgent status, redo surgery, and small LAA were the commonest reasons for non-application. Post-op anticoagulation was instituted in all with few exceptions. Four patients (2.7%) in the non-recipient group had a previous history of stroke. Two patients (1.3%) in the non-recipients had new post-op stroke whereas no patient in the recipient group had post-op stroke. Overall mortality in non-recipients was n=17, 23%, and in recipients was n=4, 5%. Conclusions Contemporary evidence supports significant thromboembolic risk reduction with Left Atrial Appendage Clip application. Our experience underpins benefits in a disease spectrum that is associated with significant morbidity and resource utilisation.