PMID- 35743478
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220716
IS  - 2077-0383 (Print)
IS  - 2077-0383 (Electronic)
IS  - 2077-0383 (Linking)
VI  - 11
IP  - 12
DP  - 2022 Jun 14
TI  - Left Atrial Appendage Amputation for Atrial Fibrillation during Aortic Valve 
      Replacement.
LID - 10.3390/jcm11123408 [doi]
LID - 3408
AB  - BACKGROUND: Occluding the left atrial appendage (LAA) during cardiac surgery 
      reduces the risk of ischemic stroke; nonetheless, it is currently only softly 
      recommended with "may be considered" by the current guidelines. We aimed to 
      assess thromboembolic risk after LAA amputation in patients with atrial 
      fibrillation (AF) and aortic stenosis undergoing biological aortic valve 
      replacement (AVR) as primary cardiac surgery. METHODS: Two cohorts were generated 
      retrospectively: patients with AF undergoing AVR alone or combined with 
      revascularization either with LAA amputation or without. Data were collected from 
      the hospital-specific data system. Follow-up was completed by telephone interview 
      or in person. Thirty-day and follow-up results were compared in patients with vs. 
      without LAA amputation. RESULTS: One hundred and fifty-seven patients were 
      investigated retrospectively, and seventy-four pairs were matched with regard to 
      baseline characteristics. Patients with LAA amputation exhibited a lower 
      incidence of cumulative and late ischemic stroke (6.4% vs. 25%, p = 0.028 and 
      3.2% vs. 20%, p = 0.008, respectively; hazard ratio 0.30; 95% confidence interval 
      0.11; 0.84; p = 0.021) during follow-up of 48 months vs. patients without 
      intervention during follow-up of 45 months, p = 0.494. No significant differences 
      were observed in postoperative stroke, 2 (2.7%) vs. 3 (4.1%), p = 1.000, 
      re-exploration for bleeding 3 (4.1%) vs. 6 (8.1), p = 0.494 or late pericardial 
      effusion 2 (2.7%) vs. 3 (4.1%), p = 1.000, in-hospital 2 (2.7%) vs. 4 (5.4%), p = 
      0.681 and all-cause mortality 15 (23.8%) vs. 9 (15%), p = 0.315 in patients with 
      vs. without LAA amputation, respectively. CONCLUSIONS: A combination of leading 
      aortic stenosis and AF in patients undergoing isolated or combined biological AVR 
      represents a subpopulation with excessive thromboembolic risk. Concomitant LAA 
      amputation during cardiac surgery reduces the risk of ischemic stroke without 
      posing an additional periprocedural risk for the patient. Therefore, the minimal 
      invasive approach at the expense of omitting LAA amputation should be discouraged 
      to maximize the clinical benefits of AVR in this setting.
FAU - Kalisnik, Jurij M
AU  - Kalisnik JM
AUID- ORCID: 0000-0002-2227-4091
AD  - Department of Cardiac Surgery, Klinikum Nurnberg, Paracelsus Medical University 
      Nuremberg, 90471 Nuremberg, Germany.
AD  - Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia.
FAU - Santarpino, Giuseppe
AU  - Santarpino G
AD  - Klinikum Nurnberg, Paracelsus Medical University, Campus Nuremberg, 90419 
      Nuremberg, Germany.
AD  - Department of Cardiac Surgery, Citta di Lecce Hospital, GVM Care & Research, 
      73100 Lecce, Italy.
AD  - Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 
      Catanzaro, Italy.
FAU - Balbierer, Andrea I
AU  - Balbierer AI
AD  - Klinikum Nurnberg, Paracelsus Medical University, Campus Nuremberg, 90419 
      Nuremberg, Germany.
FAU - Zibert, Janez
AU  - Zibert J
AUID- ORCID: 0000-0003-2312-5431
AD  - Department of Biostatistics, Faculty of Health Sciences, University of Ljubljana, 
      1000 Ljubljana, Slovenia.
FAU - Vogt, Ferdinand A
AU  - Vogt FA
AD  - Department of Cardiac Surgery, Klinikum Nurnberg, Paracelsus Medical University 
      Nuremberg, 90471 Nuremberg, Germany.
AD  - Department of Cardiac Surgery, Artemed Clinic Munich-South, 81379 Munich, 
      Germany.
FAU - Fittkau, Matthias
AU  - Fittkau M
AD  - Department of Cardiac Surgery, Klinikum Nurnberg, Paracelsus Medical University 
      Nuremberg, 90471 Nuremberg, Germany.
FAU - Fischlein, Theodor
AU  - Fischlein T
AD  - Department of Cardiac Surgery, Klinikum Nurnberg, Paracelsus Medical University 
      Nuremberg, 90471 Nuremberg, Germany.
LA  - eng
PT  - Journal Article
DEP - 20220614
PL  - Switzerland
TA  - J Clin Med
JT  - Journal of clinical medicine
JID - 101606588
PMC - PMC9224923
OTO - NOTNLM
OT  - aortic valve replacement
OT  - atrial fibrillation
OT  - ischemic stroke
OT  - left atrial amputation
COIS- The authors declare no conflict of interest.
EDAT- 2022/06/25 06:00
MHDA- 2022/06/25 06:01
PMCR- 2022/06/14
CRDT- 2022/06/24 01:24
PHST- 2022/04/16 00:00 [received]
PHST- 2022/05/25 00:00 [revised]
PHST- 2022/06/03 00:00 [accepted]
PHST- 2022/06/24 01:24 [entrez]
PHST- 2022/06/25 06:00 [pubmed]
PHST- 2022/06/25 06:01 [medline]
PHST- 2022/06/14 00:00 [pmc-release]
AID - jcm11123408 [pii]
AID - jcm-11-03408 [pii]
AID - 10.3390/jcm11123408 [doi]
PST - epublish
SO  - J Clin Med. 2022 Jun 14;11(12):3408. doi: 10.3390/jcm11123408.