Left atrial appendage obliteration in atrial fibrillation patients undergoing bioprosthetic mitral valve replacement.
BACKGROUND
Left atrial appendage (LAA) obliteration is a proven stroke-preventive measure for patients with nonvalvular atrial fibrillation (AF). However, the efficacy of LAA obliteration for patients with AF after bioprosthetic mitral valve replacement (MVR) remains unclear.


OBJECTIVE
This study aimed to estimate the efficacy of LAA obliteration in preventing embolism and to investigate the predictors of thromboembolism after bioprosthetic MVR.


METHODS
We retrospectively studied 173 AF subjects with bioprosthetic MVR; among them, 81 subjects underwent LAA obliteration using an endocardial running suture method. The main outcome measure was the occurrence of thrombosis events (TEs). The mean follow-up time was 40 ± 17 months.


RESULTS
AF rhythm was observed in 136 patients postoperatively. The incidence rate of TEs was 13.97 % for postoperative AF subjects; a dilated left atrium (LA; > 49.5 mm) was identified as an independent risk factor of TEs (OR = 10.619, 95 % CI = 2.754-40.94, p = 0.001). For postoperative AF patients with or without LAA, the incidence rate of TEs was 15.8 % (9/57) and 12.7 % (10/79; p = 0.603), respectively. The incidence rate of TEs was 2.7 % (1/36) and 4.2 % (2/48) for the subgroup patients with a left atrial diameter of < 49.5 mm, and 38.1 % (8/21) and 25.8 % (8/31) for those with a left atrial diameter of > 49.5 mm (p = 0.346).


CONCLUSIONS
Surgical LAA obliteration in patients with valvular AF undergoing bioprosthetic MVR did not reduce TEs, even when the CHA2DS2-VASc score (a score for estimating the risk of stroke in AF) was ≥ 2 points.
Department of Cardiac Surgery, Atrial Fibrillation Center, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, 100029, Chaoyang District, Beijing, China.
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Min
Department of Cardiac Surgery, Atrial Fibrillation Center, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, 100029, Chaoyang District, Beijing, China.
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Zhu
Department of Cardiac Surgery, Atrial Fibrillation Center, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, 100029, Chaoyang District, Beijing, China.
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Han
Department of Cardiac Surgery, Atrial Fibrillation Center, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, 100029, Chaoyang District, Beijing, China.
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Y
Li
Department of Cardiac Surgery, Atrial Fibrillation Center, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, 100029, Chaoyang District, Beijing, China. mxheart09@sina.com.
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Meng
D020517:Atrial Appendage / Q000601:surgery*; D001281:Atrial Fibrillation / Q000401:mortality / Q000601:surgery*; D001705:Bioprosthesis / Q000706:statistics & numerical data*; D015984:Causality; D002681:China / Q000453:epidemiology; D003131:Combined Modality Therapy / Q000706:statistics & numerical data; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality*; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013923:Thromboembolism / Q000401:mortality / Q000517:prevention & control*; D016896:Treatment Outcome
Atrial fibrillation; Bioprosthetic mitral valve replacement; Left atrial appendage; Left atrial dimension; Thrombosis events