Xuereb Linnea, Go Pauline H, Kaur Babbaljeet, Akrawe Silvy, Nemeh Hassan W, Borgi Jamil, Williams Celeste T, Paone Gaetano, Morgan Jeffrey A
Division of Cardiothoracic Surgery, Henry Ford Hospital, Heart and Vascular Institute, Detroit, Michigan.
Division of Cardiothoracic Surgery, Henry Ford Hospital, Heart and Vascular Institute, Detroit, Michigan.
Ann Thorac Surg. 2016 Nov;102(5):1543-1549. doi: 10.1016/j.athoracsur.2016.04.025. Epub 2016 Jul 25.
The incidence of atrial fibrillation (AF) among patients undergoing left ventricular assist device (LVAD) implantation is high. However, the impact of AF on clinical outcomes has not been clarified. We reviewed our 9-year experience of continuous flow (CF) LVADs to determine the impact of preoperative AF on stroke, device thrombosis, and survival.
Between March 2006 and May 2015, 231 patients underwent implantation of 240 CF LVADs, 127 (52.9%) as bridge to transplantation and 113 (47.1%) as destination therapy. Effect of AF on postoperative outcomes was assessed by using Kaplan-Meier survival and Cox proportional hazard regression.
There were 78 patients (32.5%) with preoperative AF with a mean age of 55.7 ± 11.4 years. A similar incidence of stroke was found in patients with and without AF, 12.8% versus 16.0%, respectively (p = 0.803). Survival was similar, with 1-, 6-, 12-, and 24-month survivals of 96.2%, 91.7%, 84.5%, and 69.2%, respectively, for AF patients, versus 93.1%, 85.0%, 79.4%, and 74.1%, respectively, for non-AF patients (p = 0.424). Preoperative AF was not a significant independent predictor of survival with the use of Cox proportional hazard regression (hazard ratio 1.08, 95% confidence interval: 0.66 to 1.76).
Preoperative AF was associated with a similar incidence of postoperative stroke, device thrombosis, and survival. On the basis of these data, it seems unnecessary to perform a left atrial appendage ligation or to alter postoperative anticoagulation in patients with AF undergoing LVAD implantation.
在接受左心室辅助装置（LVAD）植入的患者中，心房颤动（AF）的发生率很高。然而，AF对临床结局的影响尚未明确。我们回顾了我们9年来使用连续流（CF）LVAD的经验，以确定术前AF对中风、装置血栓形成和生存的影响。
2006年3月至2015年5月期间，231例患者接受了240台CF LVAD植入，其中127例（52.9%）作为移植桥接，113例（47.1%）作为目标治疗。通过Kaplan-Meier生存分析和Cox比例风险回归评估AF对术后结局的影响。
有78例（32.5%）患者术前患有AF，平均年龄为55.7±11.4岁。有AF和无AF的患者中风发生率相似，分别为12.8%和16.0%（p = 0.803）。生存率相似，AF患者的1个月、6个月、12个月和24个月生存率分别为96.2%、91.7%、84.5%和69.2%，而非AF患者分别为93.1%、85.0%、79.4%和74.1%（p = 0.424）。使用Cox比例风险回归分析，术前AF不是生存的显著独立预测因素（风险比1.08，95%置信区间：0.66至1.76）。
术前AF与术后中风、装置血栓形成和生存的发生率相似。基于这些数据，对于接受LVAD植入的AF患者，似乎没有必要进行左心耳结扎或改变术后抗凝治疗。
