The impact of surgical left atrial appendage amputation/ligation on stroke prevention in patients undergoing off-pump coronary artery bypass grafting.
Stroke is a major adverse event in patients developing atrial fibrillation (AF) after cardiac surgery. Surgical left atrial appendage amputation/ligation (LAA-A/L) during off-pump coronary artery bypass grafting (OPCAB) is routinely performed in our institution. We analyzed 578 consecutive patients (mean age 69 years, male 82%) undergoing OPCAB with or without concomitant LAA-A/L from 2011 to 2014 at our institution in a prospective observational manner. The safety and efficacy of the concomitant LAA-A/L on preventing early (<30 days) and overall postoperative stroke were examined. A total of 193 patients (33.4%) underwent LAA-A/L, consisting of amputation in 154 and ligation in 39 patients (80 and 20% of the cases, respectively). Preoperative characteristics, operative time, requirement of blood transfusion, and 30-day mortality were not significantly different between those with and without LAA-A/L. The incidences of postoperative AF and early and overall stroke were not significantly different between the groups in the analysis based on a total cohort. In a subanalysis of patients without LAA-A/L, early and overall stroke occurred more frequently in those developing postoperative AF than those without AF (2.8 vs. 0%; p = 0.005, 6.2 vs. 1.5%; p = 0.017, respectively), while in patients receiving LAA-A/L, stroke incidences did not differ between those with and without AF. Multivariate logistic regression showed postoperative AF without LAA-A/L as the only independent positive predictor of overall stroke (OR 3.69, p = 0.03). Concomitant LAA-A/L with OPCAB can safely prevent postoperative stroke occurrence in case patients develop AF, the most common arrhythmia associated with stroke.
Department of Cardiovascular Surgery, Heart Center, Juntendo University School of Medicine, Building 9, 1F-Room124A, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan.
Daisuke
D
Endo
Department of Cardiovascular Surgery, Heart Center, Juntendo University School of Medicine, Building 9, 1F-Room124A, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan. rinnko@sannet.ne.jp.
Tomoko S
TS
Kato
Department of Cardiovascular Surgery, Heart Center, Juntendo University School of Medicine, Building 9, 1F-Room124A, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan.
Tai
T
Iwamura
Department of Cardiovascular Surgery, Heart Center, Juntendo University School of Medicine, Building 9, 1F-Room124A, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan.
Atsumi
A
Oishi
Department of Cardiovascular Surgery, Heart Center, Juntendo University School of Medicine, Building 9, 1F-Room124A, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan.
Yasutaka
Y
Yokoyama
Department of Cardiovascular Surgery, Heart Center, Juntendo University School of Medicine, Building 9, 1F-Room124A, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan.
Kenji
K
Kuwaki
Department of Cardiovascular Surgery, Heart Center, Juntendo University School of Medicine, Building 9, 1F-Room124A, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan.
Hirotaka
H
Inaba
Department of Cardiovascular Surgery, Heart Center, Juntendo University School of Medicine, Building 9, 1F-Room124A, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan.
Atsushi
A
Amano
D000368:Aged; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D020517:Atrial Appendage / Q000601:surgery; D001281:Atrial Fibrillation / Q000401:mortality* / Q000601:surgery*; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D007564:Japan; D008026:Ligation / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000517:prevention & control*
Atrial fibrillation; Bypass grafting; Left atrial appendage; Off-pump coronary artery; Stroke prevention