Surgical left atrial appendage occlusion in patients with atrial fibrillation undergoing mechanical heart valve replacement

• Published in: Chinese medical journal 2020-08, Vol.133 (16), p.1891-1899
• Main Authors: Zheng, Ye, Rao, Chen-Fei, Chen, Si-Peng, He, Li, Hou, Jian-Feng, Zheng, Zhe
• Format: Article
• Language: English
• Subjects: Ablation; Age; Atrial Appendage - surgery; Atrial Fibrillation - surgery; Blood clots; Cardiac arrhythmia; Cardiac Surgical Procedures; Cardiovascular disease; Coronary vessels; Creatinine; Diabetes; Embolisms; Heart failure; Heart surgery; Heart Valve Prosthesis Implantation; Heart Valves; Hospitals; Humans; Hypertension; Kidneys; Mortality; Original; Postoperative Complications; Retrospective Studies; Risk Factors; Software; Standard deviation; Stroke; Surgical techniques; Thromboembolism; Treatment Outcome; Variables; Womens health
• ISSN: 0366-6999; 2542-5641
• DOI: 10.1097/CM9.0000000000000967

Surgical left atrial appendage occlusion (SLAAO) may be associated with a lower risk of thromboembolism in patients with atrial fibrillation undergoing cardiac surgery. However, evidence regarding the effectiveness of SLAAO in patients undergoing mechanical heart valve replacement (MHVR) is lacking. Therefore, we aimed to evaluate the association between SLAAO and the cardiovascular outcomes in patients with atrial fibrillation undergoing MHVR. We retrospectively analyzed data for 497 patients with atrial fibrillation; 27.6% of the patients underwent SLAAO, and the remainder of the patients did not (No-SLAAO group). The primary outcome was a composite of ischemic stroke, systemic embolism, and all-cause mortality. Cumulative event-free survival rates were estimated using Kaplan-Meier curves, and we performed multivariate Cox analyses to evaluate the association between SLAAO and outcomes. We used one-to-one propensity score matching to balance patients' baseline characteristics, and analyzed 120 matching pairs. Five patients died within 30 days postoperatively, and there were no significant differences between the two groups regarding in-hospital complications (all P > 0.05). After a median follow-up of 14 months, 14 primary events occurred. Kaplan-Meier curves showed no difference in the cumulative incidence of freedom from the primary outcome (log-rank P = 0.830), hemorrhagic events (log-rank P = 0.870), and the secondary outcome (log-rank P = 0.730), between the two groups. Multivariable Cox proportional hazards regression analysis showed no association between SLAAO and any outcome (all P > 0.05). After propensity score matching, cardiopulmonary bypass time and aortic cross-clamp time, and the postoperative length of stay were significantly longer in the SLAAO group (all P