scholarly journals The left atrial appendage amputation during off-pump coronary artery bypass grafting prevents stroke

2021 ◽  
Author(s):  
Daisuke Endo ◽  
Tohru Asai ◽  
Taira Yamamoto ◽  
Atsumi Oishi ◽  
Yasutaka Yokoyama ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Sinus Rhythm ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Artery Bypass ◽  
Atrial Appendage ◽  
Bypass Grafting ◽  
Off Pump ◽  
Pump Coronary Artery Bypass

Background: Postoperative atrial fibrillation (POAF) occurs in 20% to 50% of patients soon after cardiac surgery, and is associated with subsequent newly developed AF. Left atrial appendage closure is effective in preventing stroke among patients with nonvalvular AF. However, the prophylactic effect of left atrial appendage amputation (LAAA) in stroke prevention among patients with sinus rhythm has not been proven. Methods: We analyzed 977 consecutive patients undergoing off-pump coronary artery bypass grafting (OPCAB) with sinus rhythm, with or without concomitant LAAA, from 2011 to 2017 at our institution in a retrospective observational manner. A total of 550 patients (56.3%) underwent concomitant LAAA, any effect thereof in preventing early (<30 days) and later stroke was examined. Results: The incidences of POAF and early stroke were not significantly different between the groups. The incidence of later stroke was higher in patients without LAAA than in those with LAAA (4.0% vs. 1.6%; p = 0.02). In a subanalysis of patients without LAAA, stroke occurred more frequently in those with POAF than those without POAF (7.5% vs. 2.7%; p = 0.03), while in patients receiving LAAA, stroke incidences did not differ between those with and without POAF. Multivariate cox proportional hazard model showed POAF without LAAA was the only independent predictor of stroke (HR: 2.86; 95% CI: 1.10 to 7.45; p=0.03). Conclusions: Concomitant surgical LAA amputation during OPCAB reduces the risk of stroke.

Abstract 11813: The Impact of Surgical Left Atrial Appendage Amputation/Ligation on Stroke Prevention in Patients Undergoing Off-pump Coronary Artery Bypass Grafting

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Daisuke Endo ◽  
Tomoko S Kato ◽  
Tai Iwamura ◽  
Akie Shimada ◽  
Kan Kajimoto ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Stroke Prevention ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Off Pump ◽  
Pump Coronary Artery Bypass

Background: Stroke is a major adverse event in patients developing atrial fibrillation (AF) after cardiac surgery. Left atrial appendage (LAA) closure using devices is expected to prevent stroke and enable patients to be warfarin free; however, problems such as procedure-related adverse events and possible residual flow remain unsolved. Concomitant “surgical” LAA amputation/ligation (LAA-A/L) during off-pump coronary artery bypass grafting (OPCAB) is actively performed in our institution. Methods: This is a prospective observational study of 578 consecutive patients (mean age 69 ± 9.8 years, Male 82%) undergoing OPCAB with or without concomitant LAA-A/L from 2011 to 2014. The safety and efficacy of the concomitant procedure, performed on 193 (33%) patients, on preventing early (<30 days) and late postoperative stroke were examined. Results: LAA was amputated in 154 patients (80%), and ligated in 39 (20%). Between patients with and without LAA-A/L, no difference was seen in the preoperative characteristics including CHADS2 and CHA2DS2-VASc scores, and no significant differences in their operative time, requirement of blood transfusion, length of ICU and total hospital stay were noted. The incidence of postoperative AF was not different (33% vs. 28%, p=0.18), and early and late stroke incidences were not significantly different between the groups (1.0% vs. 0.8%, p=0.75, 2.2% vs. 2.8% p=0.67, respectively). However, in patients without LAA-A/L, both early and late stroke occurred more frequently in those developing AF (2.8% vs. 0%, p=0.005, 6.2% vs. 1.5%; p=0.017, respectively), while stroke incidence in patients receiving LAA-A/L, was not significantly different between those with and without postoperative AF (0.8% vs. 1.6%, p=0.61, 1.6% vs. 2.5%; p=0.69, respectively). Multivariate logistic regression showed postoperative AF without LAA-A/L as the only independent positive predictor of early (OR: 6.8; 95% CI: 1.11 to 52.60; p=0.04) and late (OR: 3.7; 95% CI: 1.18 to 10.94; p=0.03) stroke. Conclusions: Concomitant LAA-A/L with OPCAB is safe and effective for stroke prevention in patients developing postoperative AF. This preventative procedure seems beneficial, since AF is the most common arrhythmia associated with the risk of stroke.

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