Key result
Left atrial appendage closure alone or in combination with ablation during cardiac surgery was associated with lower one-year mortality (9.5%-12.8% vs 21.8%) and reduced stroke risk.
Why the study?
Does LAA closure during cardiac surgery reduce stroke and mortality in patients with permanent atrial fibrillation?
Cohort (n=396)
Does LAA closure during cardiac surgery reduce stroke and mortality in patients with permanent atrial fibrillation?
LAA closure during cardiac surgery in patients with permanent atrial fibrillation is associated with reduced stroke and mortality at one year.
May support surgical LAA closure in permanent AF; leaves open randomized confirmation before practice change.
Objectives: The left atrial appendage (LAA): Our most lethal human attachment? What should we do with it? An important question for surgical and interventional procedures. We analyzed the data if LAA occlusion or not is useful for the prevention of stroke and reduction of death in patients up to one year after cardiac surgery. Methods: In a prospective register study a total of 396 patients (pts) with permanent atrial fibrillation (pAF) (50.5% male; LVEF 52–58%, Mean age 68.4±9 years) were analyzed with one year follow up. Pts were divided into four different groups with pAF after a cardiac surgical operation: I: cardiac operation with isolated left atrial appendage closure (LAA) n=42; II: cardiac operation with isolated LAA closure and additional endocardial microwave ablation (EMA) n=196; III: cardiac operation with EMA without LAA closure n=71; IV: control group with isolated cardiac operation (without EMA and LAA closure) n=87. LAA closure was done in 238 pts. Results: One year mortality rate was 13% (subgroup specific: I: 9.5%; II: 12.8%; III: 7%; IV: 21.8%. Figure 1 shows the incidence of stroke in these four pts groups with a significant benefit for stroke prevention (p=0.05 to 0.01) in comparison to the control group IV. Pts in the control group IV had she shortest Op-time. Fig.1 Incidence of postoperative stroke in percent after one year in these four pts groups. Conclusions: LAA closure alone or in combination with ablation procedure shows a significant benefit for survival and stroke prevention in the treatment of pts with pAF in cardiac surgery. Therefore closure of the LAA should be recommended for all pts with atrial fibrillation.
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Knaut et al. (2012) conducted a cohort in permanent atrial fibrillation (n=396). Left atrial appendage closure (with or without endocardial microwave ablation) vs. Isolated cardiac operation without LAA closure or ablation was evaluated on One year mortality. Left atrial appendage closure alone or in combination with ablation during cardiac surgery was associated with lower one-year mortality (9.5%-12.8% vs 21.8%) and reduced stroke risk.
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