Impact of Left Atrial Appendage Closure During Cardiac Surgery on the Occurrence of Early Postoperative Atrial Fibrillation, Stroke, and Mortality: A Propensity Score Matched Analysis of 10,633 Patients

Rowlens Melduni, Hartzell V Schaff, Hon Chi Lee, Bernard J. Gersh, Peter Noseworthy, Kent R Bailey, Naser M. Ammash, Stephen S. Cha, Kaniz Fatema, Waldemar E. Wysokinski, James B. Seward, Douglas L Packer, Charanjit S. Rihal, Samuel J Asirvatham

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Abstract

BACKGROUND—: Prophylactic exclusion of the left atrial appendage (LAA) is often performed during cardiac surgery ostensibly to reduce the risk of stroke. However, the clinical impact of LAA closure in humans remains inconclusive. METHODS—: Out of 10,633 adults who underwent CABG and/or valve surgery between January 2000 and December 2005, 9,792 patients with complete baseline characteristics, surgery procedure and follow-up data were included in this analysis. A propensity-score matching analysis based on 28 pretreatment covariates was performed and 461 matching pairs were derived and analyzed to estimate the association of LAA closure with early postoperative atrial fibrillation (POAF) (AF ≤30 days of surgery), ischemic stroke and mortality. RESULTS—: In the propensity-matched cohort, the overall incidence of POAF was 53.9%. In this group, the rate of early POAF among the patients who underwent LAA closure was 68.6% vs 31.9% for those who did not undergo the procedure (P<.001). LAA closure was independently associated with an increased risk of early POAF (adjusted OR [95% CI], 3.88 [2.89-5.20]), but did not significantly influence the risk of stroke (adjusted HR [95% CI], 1.07 [0.72-1.58]) or mortality (adjusted HR [95% CI], 0.92 [0.75-1.13]). CONCLUSIONS—: After adjustment for treatment allocation bias, LAA closure during routine cardiac surgery was significantly associated with an increased risk of early POAF, but did not influence the risk of stroke or mortality. It remains uncertain whether prophylactic exclusion of the LAA is warranted for stroke prevention during non–AF-related cardiac surgery.

Original languageEnglish (US)
JournalCirculation
DOIs
StateAccepted/In press - Dec 12 2016

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Atrial Appendage
Propensity Score
Atrial Fibrillation
Thoracic Surgery
Stroke
Mortality
Ambulatory Surgical Procedures
Incidence

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

@article{164f9f8709a74d47b3710298a6936e93,
title = "Impact of Left Atrial Appendage Closure During Cardiac Surgery on the Occurrence of Early Postoperative Atrial Fibrillation, Stroke, and Mortality: A Propensity Score Matched Analysis of 10,633 Patients",
abstract = "BACKGROUND—: Prophylactic exclusion of the left atrial appendage (LAA) is often performed during cardiac surgery ostensibly to reduce the risk of stroke. However, the clinical impact of LAA closure in humans remains inconclusive. METHODS—: Out of 10,633 adults who underwent CABG and/or valve surgery between January 2000 and December 2005, 9,792 patients with complete baseline characteristics, surgery procedure and follow-up data were included in this analysis. A propensity-score matching analysis based on 28 pretreatment covariates was performed and 461 matching pairs were derived and analyzed to estimate the association of LAA closure with early postoperative atrial fibrillation (POAF) (AF ≤30 days of surgery), ischemic stroke and mortality. RESULTS—: In the propensity-matched cohort, the overall incidence of POAF was 53.9{\%}. In this group, the rate of early POAF among the patients who underwent LAA closure was 68.6{\%} vs 31.9{\%} for those who did not undergo the procedure (P<.001). LAA closure was independently associated with an increased risk of early POAF (adjusted OR [95{\%} CI], 3.88 [2.89-5.20]), but did not significantly influence the risk of stroke (adjusted HR [95{\%} CI], 1.07 [0.72-1.58]) or mortality (adjusted HR [95{\%} CI], 0.92 [0.75-1.13]). CONCLUSIONS—: After adjustment for treatment allocation bias, LAA closure during routine cardiac surgery was significantly associated with an increased risk of early POAF, but did not influence the risk of stroke or mortality. It remains uncertain whether prophylactic exclusion of the LAA is warranted for stroke prevention during non–AF-related cardiac surgery.",
author = "Rowlens Melduni and Schaff, {Hartzell V} and Lee, {Hon Chi} and Gersh, {Bernard J.} and Peter Noseworthy and Bailey, {Kent R} and Ammash, {Naser M.} and Cha, {Stephen S.} and Kaniz Fatema and Wysokinski, {Waldemar E.} and Seward, {James B.} and Packer, {Douglas L} and Rihal, {Charanjit S.} and Asirvatham, {Samuel J}",
year = "2016",
month = "12",
day = "12",
doi = "10.1161/CIRCULATIONAHA.116.021952",
language = "English (US)",
journal = "Circulation",
issn = "0009-7322",
publisher = "Lippincott Williams and Wilkins",

}

TY - JOUR

T1 - Impact of Left Atrial Appendage Closure During Cardiac Surgery on the Occurrence of Early Postoperative Atrial Fibrillation, Stroke, and Mortality

T2 - A Propensity Score Matched Analysis of 10,633 Patients

AU - Melduni, Rowlens

AU - Schaff, Hartzell V

AU - Lee, Hon Chi

AU - Gersh, Bernard J.

AU - Noseworthy, Peter

AU - Bailey, Kent R

AU - Ammash, Naser M.

AU - Cha, Stephen S.

AU - Fatema, Kaniz

AU - Wysokinski, Waldemar E.

AU - Seward, James B.

AU - Packer, Douglas L

AU - Rihal, Charanjit S.

AU - Asirvatham, Samuel J

PY - 2016/12/12

Y1 - 2016/12/12

N2 - BACKGROUND—: Prophylactic exclusion of the left atrial appendage (LAA) is often performed during cardiac surgery ostensibly to reduce the risk of stroke. However, the clinical impact of LAA closure in humans remains inconclusive. METHODS—: Out of 10,633 adults who underwent CABG and/or valve surgery between January 2000 and December 2005, 9,792 patients with complete baseline characteristics, surgery procedure and follow-up data were included in this analysis. A propensity-score matching analysis based on 28 pretreatment covariates was performed and 461 matching pairs were derived and analyzed to estimate the association of LAA closure with early postoperative atrial fibrillation (POAF) (AF ≤30 days of surgery), ischemic stroke and mortality. RESULTS—: In the propensity-matched cohort, the overall incidence of POAF was 53.9%. In this group, the rate of early POAF among the patients who underwent LAA closure was 68.6% vs 31.9% for those who did not undergo the procedure (P<.001). LAA closure was independently associated with an increased risk of early POAF (adjusted OR [95% CI], 3.88 [2.89-5.20]), but did not significantly influence the risk of stroke (adjusted HR [95% CI], 1.07 [0.72-1.58]) or mortality (adjusted HR [95% CI], 0.92 [0.75-1.13]). CONCLUSIONS—: After adjustment for treatment allocation bias, LAA closure during routine cardiac surgery was significantly associated with an increased risk of early POAF, but did not influence the risk of stroke or mortality. It remains uncertain whether prophylactic exclusion of the LAA is warranted for stroke prevention during non–AF-related cardiac surgery.

AB - BACKGROUND—: Prophylactic exclusion of the left atrial appendage (LAA) is often performed during cardiac surgery ostensibly to reduce the risk of stroke. However, the clinical impact of LAA closure in humans remains inconclusive. METHODS—: Out of 10,633 adults who underwent CABG and/or valve surgery between January 2000 and December 2005, 9,792 patients with complete baseline characteristics, surgery procedure and follow-up data were included in this analysis. A propensity-score matching analysis based on 28 pretreatment covariates was performed and 461 matching pairs were derived and analyzed to estimate the association of LAA closure with early postoperative atrial fibrillation (POAF) (AF ≤30 days of surgery), ischemic stroke and mortality. RESULTS—: In the propensity-matched cohort, the overall incidence of POAF was 53.9%. In this group, the rate of early POAF among the patients who underwent LAA closure was 68.6% vs 31.9% for those who did not undergo the procedure (P<.001). LAA closure was independently associated with an increased risk of early POAF (adjusted OR [95% CI], 3.88 [2.89-5.20]), but did not significantly influence the risk of stroke (adjusted HR [95% CI], 1.07 [0.72-1.58]) or mortality (adjusted HR [95% CI], 0.92 [0.75-1.13]). CONCLUSIONS—: After adjustment for treatment allocation bias, LAA closure during routine cardiac surgery was significantly associated with an increased risk of early POAF, but did not influence the risk of stroke or mortality. It remains uncertain whether prophylactic exclusion of the LAA is warranted for stroke prevention during non–AF-related cardiac surgery.

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U2 - 10.1161/CIRCULATIONAHA.116.021952

DO - 10.1161/CIRCULATIONAHA.116.021952

M3 - Article

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AN - SCOPUS:85003968492

JO - Circulation

JF - Circulation

SN - 0009-7322

ER -