title: Routine left atrial appendage ligation during cardiac surgery may prevent postoperative atrial fibrillation-related cerebrovascular accident.
abstract: OBJECTIVE
  The aim of the study was to determine whether routine left atrial appendage ligation in cardiac surgery would reduce the risk of postoperative atrial fibrillation-related cerebrovascular accident.
  
  
  METHODS
  We performed an institutional review board-approved, case-control, retrospective chart review of adult patients who underwent cardiac surgery by a single surgeon between January 1, 2001, and December 31, 2010. Preoperative CHADS(2) score criteria were collected, and outcomes through postoperative day 30 were analyzed.
  
  
  RESULTS
  A total of 2067 patients were reviewed. Propensity score matching was used to create matched groups based on left atrial appendage ligation, and 631 patients were matched in each group. Subjects with postoperative atrial fibrillation were 2.4 times (95% confidence interval, 1.51-2.82) more likely to undergo valve surgery, 2.11 times (95% confidence interval, 1.56-2.86) more likely to be aged more than 75 years, and 1.36 times (95% confidence interval, 1.03-1.80) more likely to have undergone left atrial appendage ligation. In the left atrial appendage ligation group with postoperative atrial fibrillation (n = 145), there were zero subjects (0%) with a postoperative cardiovascular accident. In the non-left atrial appendage ligation group with postoperative atrial fibrillation (n = 115), there were 7 subjects (6.1%) with a postoperative cardiovascular accident (0.0% vs 6.1%, P = .003).
  
  
  CONCLUSIONS
  Although postoperative atrial fibrillation remains a common complication of cardiac surgery, there was a significant decrease in the incidence of postoperative cerebrovascular accidents since routine ligation of the left atrial appendage was undertaken. This has been found to be a safe adjunct to a wide variety of cardiac procedures and therefore deserves further study by a larger randomized controlled trial.
authors.affiliation: Department of Surgery, Central Michigan University Healthcare, Central Michigan University College of Medicine, Saginaw, MI, USA. ryan.kim@cmich.edu
authors.forename: Ryan
authors.initials: R
authors.lastname: Kim
authors.forename: Norbert
authors.initials: N
authors.lastname: Baumgartner
authors.forename: John
authors.initials: J
authors.lastname: Clements
mesh_terms: D000368:Aged; D020517:Atrial Appendage / Q000601:surgery*; D001281:Atrial Fibrillation / Q000453:epidemiology / Q000517:prevention & control*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D015994:Incidence; D008026:Ligation; D016015:Logistic Models; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D016017:Odds Ratio; D057216:Propensity Score; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome