What does this research mean for the field?

Surgical left atrial appendage closure during cardiac surgery significantly reduces the incidence of thromboembolic events and improves 1-year survival in patients with atrial fibrillation. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

January 1, 2016Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery

Reduced Incidence of Thromboembolic Events after Surgical Closure of Left Atrial Appendage in Patients with Atrial Fibrillation

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Permanent atrial fibrillation (n=398). Intervention: Surgical left atrial appendage closure (alone or with surgical ablation) vs. No concomitant surgical ablation or left atrial appendage closure. Primary outcome: Thromboembolic events (p=<0.01).

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Key result

Surgical LAA closure linked to ~68% fewer 1-year thromboembolic events versus no closure.

P<0.01
n=398

Why the study?

Whether the benefits of interventional left atrial appendage closure in reducing thromboembolic events can be fully translated to surgical LAA closure in patients with AF undergoing cardiac surgery was unclear and data were lacking.

Does surgical left atrial appendage closure reduce thromboembolic events and death in patients with permanent atrial fibrillation undergoing cardiac surgery?

Study Design

Type

Observational (n=398)

Structured PICO

Does surgical left atrial appendage closure reduce thromboembolic events and death in patients with permanent atrial fibrillation undergoing cardiac surgery?

Population

398 patients with permanent atrial fibrillation undergoing cardiac surgery, followed for 1 year.

Exposure

Surgical left atrial appendage (LAA) closure, either isolated (n=44) or combined with surgical ablation (n=196).

Comparator

No LAA closure (either isolated surgical ablation [n=71] or no concomitant surgical ablation/LAA closure [n=87]).

Outcome

Thromboembolic events and death from any cause at 1-year follow-up.hard clinical

Main Result

Absolute Event Rate: 6.6% vs 20.5%

p-value: p=<0.01

Surgical left atrial appendage closure during cardiac surgery in patients with permanent atrial fibrillation is associated with significantly reduced thromboembolic events and improved 1-year survival.

Implication

May support surgical LAA closure during cardiac surgery; hypothesis-generating pending randomized confirmation.

Abstract

OBJECTIVE: Most of the detected thrombi in patients with atrial fibrillation (AF) can be found in the left atrial appendage (LAA). Interventional LAA closure recently proved to be noninferior to warfarin therapy. Whether these results can be fully translated into surgical LAA closure remains unclear. Corresponding data are still lacking. The present observational study evaluated the impact of surgical LAA closure in patients with AF undergoing cardiac surgery on postoperative thromboembolic events. METHODS: A prospective registry enrolled 398 patients with permanent AF undergoing cardiac surgery. Concomitant procedures were isolated surgical ablation (group I, n = 71), isolated LAA closure (group II, n = 44), and combined surgical ablation and LAA closure (group III, n = 196). The control group consisted of 87 patients without concomitant surgical ablation or LAA closure. One-year follow-up was completed in all patients. End points were thromboembolic events and death from any cause. RESULTS: Clinical baseline characteristics were comparable among the groups. General hospital mortality was 5.5% and likewise differed not significantly. Postoperatively, mean (SD) CHAD2S2-VASc score of 3.5 (1.3) differed not significantly among the groups, indicating comparable thromboembolic risk. Follow-up referred to all hospital survivors (n = 376). Herein, overall incidence of thromboembolic events was 9.8% (n = 37), with an associated mortality of 41.0%. Patients with LAA closure alone or in combination with surgical ablation had a significantly reduced incidence of thromboembolic events (6.6% vs 20.5%, P < 0.01) and consecutively improved survival after 1 year of follow-up (7.0% vs 17.1%, P < 0.01). CONCLUSIONS: Left atrial appendage closure alone or in combination with surgical ablation was associated with a significantly reduced rate of thromboembolic events and consecutively improved survival after 1 year of follow-up.

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Cite This Study

Wilbring et al. (2016) conducted an observational in Permanent atrial fibrillation (n=398). Surgical left atrial appendage closure (alone or with surgical ablation) vs. No concomitant surgical ablation or left atrial appendage closure was evaluated on Thromboembolic events (p=<0.01). Surgical left atrial appendage closure during cardiac surgery significantly reduced the incidence of thromboembolic events compared to no closure (6.6% vs 20.5%, P<0.01) at 1 year of follow-up.

synapsesocial.com/papers/6ab3390c2d4ed7c91089479d https://doi.org/10.1097/imi.0000000000000231