What is the clinical evidence from this study?

Study design: Editorial. Population: Atrial fibrillation. Intervention: Left atrial appendage closure/amputation.

What question did this study set out to answer?

To evaluate the efficacy and safety of concomitant left atrial appendage closure or amputation during cardiac surgery for reducing early stroke risk.

January 1, 2015Circulation JournalOpen Access

Closure of the Left Atrial Appendage During Cardiac Surgery – Why, When and How? –

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Key result

Concomitant left atrial appendage closure during cardiac surgery offers a strategy to reduce stroke risk in patients with atrial fibrillation, though incomplete closure may paradoxically increase thrombus risk.

Why the study?

Does concomitant left atrial appendage closure/amputation (LAAC/A) reduce the incidence of cerebrovascular accidents in patients undergoing cardiac surgery?

Key Points

To evaluate the efficacy and safety of concomitant left atrial appendage closure or amputation during cardiac surgery for reducing early stroke risk.
Evaluated outcomes from Kato et al. comparing cardiac surgery patients with and without concomitant left atrial appendage closure or amputation (LAAC/A).
Assessed the primary efficacy endpoint of cerebrovascular accident (CVA) incidence at 6 months postoperatively alongside procedure-related safety complications, stratified by atrial fibrillation status.
The left atrial appendage accounts for up to 90% of left atrial blood clots in nonvalvular atrial fibrillation and 57% in valvular atrial fibrillation.
Atrial fibrillation increases the risk of stroke by at least fivefold, with up to 20% of all ischemic strokes directly attributable to this arrhythmia.

Structured PICO

Does concomitant left atrial appendage closure/amputation (LAAC/A) reduce the incidence of cerebrovascular accidents in patients undergoing cardiac surgery?

Population

Patients undergoing cardiac surgery

Intervention

Concomitant left atrial appendage closure/amputation (LAAC/A)

Comparator

Without LAAC/A

Outcome

Incidence of cerebrovascular accidents (CVA) at 6 monthshard clinical

Limitations

Incomplete LAA closure may be worse than no closure at all due to stagnant blood and thrombus formation
Long-term follow-up is warranted to ensure completeness of LAA closure

Implication

This editorial discusses the efficacy and safety of concomitant left atrial appendage closure during cardiac surgery for stroke prevention.

Abstract

In this issue of Journal, Kato et al on the effect of concomitant LAA closure/amputation (LAAC/A) at the time cardiac on early outcome (6 months) after the procedure. Their efficacy endpoint was the incidence of cerebrovascular accidents (CVA), while their safety endpoints were comorbidities associated with LAAC/A. As a primary they compared outcomes in patients with and without LAAC/A, and they further stratified patients according to the trial fibrillation (AF) is a common cardiac arrhythmia, present in 1-2% of the general population. Its prevalence is projected to increase approximately 2.5-fold by the year 2015. 1 The risk of developing stroke is at least 5-fold higher in patients with AF than in those without AF. 2 Approximately 90% of all strokes are ischemic and 15-20% of all ischemic strokes are associated with AF. 3-5 The left atrial appendage (LAA) has been identified as the source of up to 90% of LA thrombi in nonvalvular AF and 57% in valvular AF.

Discussion

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Cite This Study

Bando et al. (2015) conducted an editorial in Atrial fibrillation. Left atrial appendage closure/amputation was evaluated. Concomitant left atrial appendage closure during cardiac surgery offers a strategy to reduce stroke risk in patients with atrial fibrillation, though incomplete closure may paradoxically increase thrombus risk.

synapsesocial.com/papers/6a97aae460ee10bf83a66d5b https://doi.org/10.1253/circj.cj-15-1168