Left atrial appendage resection versus preservation during the surgical ablation of atrial fibrillation.
BACKGROUND
Left atrial appendage (LAA) resection during the Maze procedure may decrease thromboembolic risks, but its preservation may improve left atrial contractile function. This study compared the clinical effects of LAA resection and preservation after the Maze procedure.


METHODS
A retrospective review was made of 379 patients (mean age 53.3 ± 12.6 years, 244 females) who underwent the cryo-Maze procedure in conjunction with mitral surgery from 1999 to 2011. The LAA was resected in 187 patients (resection group) but preserved in 192 patients (preservation group). Outcomes were compared using a propensity score study design based on 20 baseline characteristics to obtain well-matched patient pairs.


RESULTS
Propensity score matching yielded 119 pairs of patients in whom there were no significant differences in baseline profiles between the two groups. During a mean follow-up of 3.1 ± 2.8 years, there were 16 deaths, 6 cases of stroke, and 39 cases of atrial fibrillation recurrence. There were no significant differences in stroke-free survival (p = 0.88) and freedom from AF while off antiarrhythmic drugs (p = 0.46) between the two groups. On serial echocardiographic assessments, patients in the preservation group showed a higher transmitral A-wave velocity (peak atrial contraction wave velocity; p = 0.47, 0.020, and 0.001 at 3, 6, and 12 months, respectively) and lower E/A ratio (peak early filling wave [E-wave] velocity / A-wave velocity; p = 0.34, 0.065, and 0.001 at 3, 6, and 12 months, respectively) at each timepoint compared with the resection group.


CONCLUSIONS
Preservation of the LAA during the Maze procedure resulted in similar clinical and rhythm outcomes, but LA contractile function superior to that of LAA resection.
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Chee-Hoon
CH
Lee
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Joon Bum
JB
Kim
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Sung-Ho
SH
Jung
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Suk Jung
SJ
Choo
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Cheol Hyun
CH
Chung
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. Electronic address: jwlee@amc.seoul.kr.
Jae Won
JW
Lee
D000328:Adult; D000368:Aged; D020517:Atrial Appendage / Q000000981:diagnostic imaging / Q000601:surgery*; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods* / Q000401:mortality; D015331:Cohort Studies; D017548:Echocardiography, Transesophageal; D004562:Electrocardiography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome; D057832:Watchful Waiting
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