title: Left Atrial Appendage Closure Reduces the Incidence of Postoperative Cerebrovascular Accident in Patients Undergoing Cardiac Surgery.
abstract: BACKGROUND
  Cerebrovascular accidents (CVA) are a major adverse event following cardiac surgery, for which atrial fibrillation (AF) is considered as a risk factor. We have recently performed left atrial appendage (LAA) surgical closure or amputation (LAAC/A), which is the main source of emboli, during open-heart surgery.
  
  
  RESULTS
  A prospective observational study of 1,831 consecutive patients (69.2% male, aged 66.8±12.2 years) undergoing cardiac surgery between 2009 and 2013 was performed. The incidence of postoperative CVA within 6 months in patients with and without LAAC/A was compared. We further stratified patients according to their risk of CVA using CHA2DS2-VASc score; dichotomizing low-risk (score <2) and high-risk groups (≥2). A total of 369 patients (20.2%) underwent LAAC/A. Although these patients had larger left atrial diameter preoperatively and developed postoperative AF more frequently than those without LAAC/A (45.4 vs. 41.1 mm, 49.3 vs. 39.1%, respectively, both P<0.001), the CVA incidence was not different between the groups (3.5 vs. 3.0%, P=0.612). Multivariate analysis revealed no association between LAAC/A and CVA in patients with CHA2DS2-VASc score ≥2, whereas in patients with CHA2DS2-VASc score <2, LAAC/A was the only and independent factor negatively associated with CVA development (odds ratio <10(-6); P=0.021).
  
  
  CONCLUSIONS
  Additional LAA procedure at the time of cardiac surgery reduces the incidence of early postoperative CVA in patients with low CHA2DS2-VASc score.
authors.affiliation: Department of Cardiovascular Surgery, Juntendo University.
authors.forename: Tomoko S
authors.initials: TS
authors.lastname: Kato
authors.forename: Tai
authors.initials: T
authors.lastname: Iwamura
authors.forename: Daisuke
authors.initials: D
authors.lastname: Endo
authors.forename: Yasutaka
authors.initials: Y
authors.lastname: Yokoyama
authors.forename: Atsumi
authors.initials: A
authors.lastname: Oishi
authors.forename: Akie
authors.initials: A
authors.lastname: Shimada
authors.forename: Taira
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Kenji
authors.initials: K
authors.lastname: Kuwaki
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Inaba
authors.forename: Atsushi
authors.initials: A
authors.lastname: Amano
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D012307:Risk Factors