Archive | 2021
The left atrial appendage amputation during off-pump coronary artery bypass grafting prevents stroke
Abstract
Background: Postoperative atrial fibrillation (POAF) occurs in 20% to\n50% of patients soon after cardiac surgery, and is associated with\nsubsequent newly developed AF. Left atrial appendage closure is\neffective in preventing stroke among patients with nonvalvular AF.\nHowever, the prophylactic effect of left atrial appendage amputation\n(LAAA) in stroke prevention among patients with sinus rhythm has not\nbeen proven. Methods: We analyzed 977 consecutive patients undergoing\noff-pump coronary artery bypass grafting (OPCAB) with sinus rhythm, with\nor without concomitant LAAA, from 2011 to 2017 at our institution in a\nretrospective observational manner. A total of 550 patients (56.3%)\nunderwent concomitant LAAA, any effect thereof in preventing early\n(<30 days) and later stroke was examined. Results: The\nincidences of POAF and early stroke were not significantly different\nbetween the groups. The incidence of later stroke was higher in patients\nwithout LAAA than in those with LAAA (4.0% vs. 1.6%; p = 0.02). In a\nsubanalysis of patients without LAAA, stroke occurred more frequently in\nthose with POAF than those without POAF (7.5% vs. 2.7%; p = 0.03),\nwhile in patients receiving LAAA, stroke incidences did not differ\nbetween those with and without POAF. Multivariate cox proportional\nhazard model showed POAF without LAAA was the only independent predictor\nof stroke (HR: 2.86; 95% CI: 1.10 to 7.45; p=0.03). Conclusions:\nConcomitant surgical LAA amputation during OPCAB reduces the risk of\nstroke.