Abstract 13614: Left Atrial Appendage Closure Significantly Reduces the Incidence of Post-operative Cerebrovascular Accidents in Patients Undergoing Cardiac Surgery: Analysis Based on a Single Center Prospective Observational Study
Background: Post-operative cerebrovascular accidents (CVA) are associated with increased mortality and morbidity in patients undergoing cardiac surgery. Atrial fibrillation (AF) has been considered as a major risk factor of CVA. Since the left atrial appendage (LAA) is the main source of emboli, we have performed simultaneous LAA closure or amputation (LAAC) in all patients with enlarged left atrium except for those contraindicated. In the present study, we investigated the effect of LAAC on preventing post-operative CVA.
Methods: The study prospectively enrolled 1856 consecutive patients (69.1% male, mean age 66.8±12.2 year old) undergoing cardiac surgery between January 2009 and October 2013 at our institution, including 805 cases (43.3%) of coronary artery bypass surgery (CABG) and 803 cases (43.3%) of valvular surgery. The incidence of early post-operative CVA in patients with and without LAAC was compared. We further stratified patients according to their risk of CVA using CHA2DS2-VASc score; dichotomizing low-risk group (score<2) and high-risk group (≧2).
Results: A total of 375 patients (20.2%) received LAAC. Patients undergoing LAAC had larger LA diameter preoperatively and developed post-operative Af more frequently than those without LAAC (45.4 vs. 41.2 mm, p<0.0001, 48.5 vs. 39.0%, p=0.0008, respectively) irrespective of the procedure. However, the incidence of CVA was not different between the groups (3.7% vs. 3.0%, p=0.4933). Multivariate analysis revealed that LAAC was not associated with CVA prevention in patients with CHA2DS2-VASc score≧2, whereas in patients with CHA2DS2-VASc score <2, LAAC was the only and independent factor associated with CVA prevention (odds ratio <10-6 p=0.0219).In patients with CHA2DS2 VASc score≧2, post-operative Af tended to be associated with CVA (odds ratio1.95, p=0.08); however, in patients with low CHA2DS2-VASc score, post-operative Af was not associated with CVA development
Conclusions: Additional LAA procedure at the time of cardiac surgery did not reduce the incidence of Af; however, the procedure significantly prevented CVA development especially in patients with low CHA2DS2-VASc score.
Author Disclosures: T. Iwamura: None. T.S. Kato: None. H. Nakamura: None. Y. Yokoyama: None. K. Kuwaki: None. T. Morita: None. H. Inaba: None. T. Yamamoto: None. A. Amano: None.
- © 2014 by American Heart Association, Inc.