Cardiovascular Outcomes With Surgical Left Atrial Appendage Exclusion in Patients With Atrial Fibrillation Who Underwent Valvular Heart Surgery (from the National Inpatient Sample Database)

Elbadawi, Ayman; Olorunfemi, Odunayo; Ogunbayo, Gbolahan; Saad, Marwan; Elgendy, Islam Y.; Arif, Zainab; Badran, Haitham; Saheed, Deola; Ahmed, Hamdy; Rao, Mohan

doi:10.1016/j.amjcard.2017.03.037

Cited by 42 publications

(30 citation statements)

References 21 publications

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“…However, due to the inconsistencies of the surgical LAA closure techniques and follow-up strategies, a definite recommendation of a safe, easy-toperform procedure could not be drawn from this publication. In fact, in the face of the different techniques with different outcomes, the early postoperative complication rate, even including inhospital deaths, was significantly higher than in the non-treatment group [34]. These data support the surgical concomitant LAA exclusion procedure, but further clarification from the results of RCTs needs to be performed by the cardiothoracic society to put the surgical treatment of LAA on a robust scientific base.…”

Section: Surgical Treatment Options For the Left Atrial Appendagementioning

confidence: 77%

Surgical management of the left atrial appendage: a must or a myth?

Hanke

2018

European Journal of Cardio-Thoracic Surgery

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Surgical treatment of the left atrial appendage (LAA) has increased over the past few years. The most serious complication of atrial fibrillation is a cerebral cardioembolic stroke. In most patients with atrial fibrillation, the LAA is the anatomical source of the embolism. Several surgical techniques for occluding the LAA using different devices have been developed with different prospects of success. It is still not clear which of these techniques represents the optimum treatment for reducing the incidence of stroke in patients with atrial fibrillation. This text focuses on the surgical closure of LAA and critically considers the results with respect to closure success and the associated complications.

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Section: Surgical Treatment Options For the Left Atrial Appendagementioning

confidence: 77%

Surgical management of the left atrial appendage: a must or a myth?

Hanke

2018

European Journal of Cardio-Thoracic Surgery

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“…Among these nine observational studies, four were propensity matching studies[ 5 , 6 , 10 , 13 ]. one was case matching study[ 12 ]. The inter-reviewer agreement on study eligibility was 100%.…”

Section: Resultsmentioning

confidence: 99%

“…The primary cardiac operation varied widely. The surgical procedures were primarily valve surgery in the studies by Garcia-Fernandez, Nagpal, Lee and Elbadawi[ 3 , 5 , 8 , 12 ], while they were primarily coronary artery bypass grafting (CABG) in the studies by Healey, and Elbadawi[ 7 , 11 ]. Remaining studies included a combination of valve surgery and CABG.…”

Section: Resultsmentioning

confidence: 99%

Surgical left atrial appendage occlusion during cardiac surgery: A systematic review and meta-analysis

Atti

Narayanan

Turagam

et al. 2018

WJC

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AIMTo evaluate the safety and efficacy of surgical left atrial appendage occlusion (s-LAAO) during concomitant cardiac surgery.METHODSWe performed a comprehensive literature search through May 31st 2018 for all eligible studies comparing s-LAAO vs no occlusion in patients undergoing cardiac surgery. Clinical outcomes during follow-up included: embolic events, stroke, all-cause mortality, atrial fibrillation (AF), reoperation for bleeding and postoperative complications. We further stratified the analysis based on propensity matched studies and AF predominance.RESULTSTwelve studies (n = 40107) met the inclusion criteria. s-LAAO was associated with lower risk of embolic events (OR: 0.63, 95%CI: 0.53-0.76; P < 0.001) and stroke (OR: 0.68, 95%CI: 0.57-0.82; P < 0.0001). Stratified analysis demonstrated this association was more prominent in the AF predominant strata. There was no significant difference in the incidence risk of all-cause mortality, AF, and reoperation for bleeding and postoperative complications.CONCLUSIONConcomitant s-LAAO during cardiac surgery was associated with lower risk of follow-up thromboembolic events and stroke, especially in those with AF without significant increase in adverse events. Further randomized trials to evaluate long-term benefits of s-LAAO are warranted.

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“…[ 5 , 19 ] However, there is no conclusive evidence that SLAAO reduces stroke risk in patients with atrial fibrillation undergoing cardiac surgery. Recently, several retrospective studies [ 9 , 10 , 20 ] and meta-analyses [ 11 – 13 ] showed that SLAAO is associated with a lower incidence of ischemic stroke or systemic embolism and mortality in patients undergoing cardiac surgery. Friedman et al [ 10 ] published a retrospective study involving 10,524 patients aged ≥65 years with atrial fibrillation undergoing cardiac surgery and found that SLAAO was associated with a significantly lower risk of readmission for thromboembolism and all-cause mortality during a 3-year follow-up.…”

Section: Discussionmentioning

confidence: 99%