Surgical ablation, left atrial appendage occlusion or both? Nationwide registry analysis of cardiac surgery patients with underlying atrial fibrillation

The aim of this study was to evaluate in-hospital outcomes and long-term survival of patients undergoing cardiac surgery with preoperative atrial fibrillation (AF). We compared different strategies, including no-AF treatment, left atrial appendage occlusion (LAAO) alone, concomitant surgical ablatio...

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Published in:European journal of cardio-thoracic surgery 2024-03, Vol.65 (3)
Main Authors: Pasierski, Michał, Batko, Jakub, Kuźma, Łukasz, Wańha, Wojciech, Jasiński, Marek, Widenka, Kazimierz, Deja, Marek, Bartuś, Krzysztof, Hirnle, Tomasz, Wojakowski, Wojciech, Lorusso, Roberto, Tobota, Zdzisław, Maruszewski, Bohdan J, Suwalski, Piotr, Kowalewski, Mariusz
Format: Article
Language:English
Subjects:
Atrial Appendage - surgery
Atrial Fibrillation - complications
Atrial Fibrillation - epidemiology
Atrial Fibrillation - surgery
Cardiac Surgical Procedures - methods
Humans
Registries
Retrospective Studies
Stroke
Treatment Outcome
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Summary:The aim of this study was to evaluate in-hospital outcomes and long-term survival of patients undergoing cardiac surgery with preoperative atrial fibrillation (AF). We compared different strategies, including no-AF treatment, left atrial appendage occlusion (LAAO) alone, concomitant surgical ablation (SA) alone or both. A retrospective analysis using the KROK registry included all patients with preoperative diagnosis of AF who underwent cardiac surgery in Poland between between January 2012 and December 2022. Risk adjustment was performed using regression analysis with inverse probability weighting of propensity scores. We assessed 6-year survival with Cox proportional hazards models. Sensitivity analysis was performed based on index cardiac procedure. Initially, 42 510 patients with preoperative AF were identified, and, after exclusion, 33 949 included in the final analysis. A total of 1107 (3.26%) received both SA and LAAO, 1484 (4.37%) received LAAO alone, 3921 (11.55%) SA alone and the remaining 27 437 (80.82%) had no AF-directed treatment. As compared to no treatment, all strategies were associated with survival benefit over 6-year follow-up. A gradient of treatment was observed with the highest benefit associated with SA + LAAO followed by SA alone and LAAO alone (log-rank P 
ISSN:1873-734X
1873-734X
DOI:10.1093/ejcts/ezae014