Left atrial appendage closure during cardiac surgery: Safe but underutilized in California

Left atrial appendage (LAA) closure is associated with reduced rates of stroke in patients with atrial fibrillation (AF). We evaluated trends in LAA closure, the association of LAA closure with stroke/systemic embolism, and its safety profile in patients with AF who underwent cardiac surgery in Cali...

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Bibliographic Details
Published in:JTCVS open 2023-03, Vol.13, p.150-162
Main Authors: Hadaya, Joseph, Hernandez, Roland, Sanaiha, Yas, Danielsen, Beate, Carey, Joseph, Shemin, Richard J., Benharash, Peyman
Format: Article
Language:English
Subjects:
Adult: Coronary
atrial fibrillation
coronary artery bypass grafting
left atrial appendage closure
left atrial appendage occlusion
mitral valve
valve surgery
variation in care
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Summary:Left atrial appendage (LAA) closure is associated with reduced rates of stroke in patients with atrial fibrillation (AF). We evaluated trends in LAA closure, the association of LAA closure with stroke/systemic embolism, and its safety profile in patients with AF who underwent cardiac surgery in California. We further tested for hospital-level variation in concomitant LAA closure. Adults who underwent coronary artery bypass grafting and/or valve surgery with preoperative AF were identified in the 2016 to 2019 Office of Statewide Health Planning and Development databases. Propensity score matching was performed to study risk-adjusted associations of LAA closure with ischemic stroke/systemic embolism. Hospital-level variation was studied using intraclass correlation coefficients. Among 18,434 patients with AF who underwent coronary artery bypass grafting/valve surgery, 47.7% received LAA closure. Rates of LAA closure increased from 44.4% to 51.4% from 2016 to 2019 (P 
ISSN:2666-2736
2666-2736
DOI:10.1016/j.xjon.2022.11.016