Left Atrial Appendage Amputation for Atrial Fibrillation during Aortic Valve Replacement
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Le résumé fourni par la source
Background. Occluding the left atrial appendage (LAA) during cardiac surgery reduces the risk of ischemic stroke; nonetheless, it is currently only softly recommended with “may be considered” by the current guidelines. We aimed to assess thromboembolic risk after LAA amputation in patients with atrial fibrillation (AF) and aortic stenosis undergoing biological aortic valve replacement (AVR) as primary cardiac surgery. Methods. Two cohorts were generated retrospectively: patients with AF undergoing AVR alone or combined with revascularization either with LAA amputation or without. Data were collected from the hospital-specific data system. Follow-up was completed by telephone interview or in person. Thirty-day and follow-up results were compared in patients with vs. without LAA amputation. Results. One hundred and fifty-seven patients were investigated retrospectively, and seventy-four pairs were matched with regard to baseline characteristics. Patients with LAA amputation exhibited a lower incidence of cumulative and late ischemic stroke (6.4% vs. 25%, p = 0.028 and 3.2% vs. 20%, p = 0.008, respectively; hazard ratio 0.30; 95% confidence interval 0.11; 0.84; p = 0.021) during follow-up of 48 months vs. patients without intervention during follow-up of 45 months, p = 0.494. No significant differences were observed in postoperative stroke, 2 (2.7%) vs. 3 (4.1%), p = 1.000, re-exploration for bleeding 3 (4.1%) vs. 6 (8.1), p = 0.494 or late pericardial effusion 2 (2.7%) vs. 3 (4.1%), p = 1.000, in-hospital 2 (2.7%) vs. 4 (5.4%), p = 0.681 and all-cause mortality 15 (23.8%) vs. 9 (15%), p = 0.315 in patients with vs. without LAA amputation, respectively. Conclusions. A combination of leading aortic stenosis and AF in patients undergoing isolated or combined biological AVR represents a subpopulation with excessive thromboembolic risk. Concomitant LAA amputation during cardiac surgery reduces the risk of ischemic stroke without posing an additional periprocedural risk for the patient. Therefore, the minimal invasive approach at the expense of omitting LAA amputation should be discouraged to maximize the clinical benefits of AVR in this setting.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Left Atrial Appendage Amputation for Atrial Fibrillation during Aortic Valve Replacement
- Date Crossref
- 14/06/2022
- Éditeur
- MDPI AG
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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University of Ljubljana pays non établi dans la noticeUniversité ou école supérieure
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Nuremberg Hospital pays non établi dans la noticeÉtablissement de santé
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Magna Graecia University Department of Experimental and Clinical Medicine pays non établi dans la noticeUniversité ou école supérieure
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Istituto Nazionale di Fisica Nucleare pays non établi dans la noticeStructure de recherche
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München Klinik pays non établi dans la noticeÉtablissement de santé
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Artemed SE (Germany) pays non établi dans la noticeEntreprise
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Paracelsus Medical University Nuremberg Department of Cardiac Surgery pays non établi dans la noticeUniversité ou école supérieure
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Faculty of Medicine pays non établi dans la noticeUniversité ou école supérieure
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Città di Lecce Hospital Department of Cardiac Surgery pays non établi dans la noticeÉtablissement de santé
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Faculty of Health Sciences Department of Biostatistics pays non établi dans la noticeUniversité ou école supérieure
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Artemed Clinic Munich-South Department of Cardiac Surgery pays non établi dans la noticeÉtablissement de santé
University of Ljubljana, Nuremberg Hospital et Department of Experimental and Clinical Medicine — Magna Graecia University, avec 8 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.