Effects of left atrial appendage surgical treatment on the incidence of ischemic cerebrovascular accidents in patients with atrial fibrillation undergoing cardiac surgery.

BACKGROUND

We sought to assess different surgical methods for left atrial appendage treatment to determine whether any could reduce the incidence of atrial fibrillation-related long-term ischemic cerebrovascular accidents.

METHODS

A total of 1243 patients were treated with left atrial appendage removal, and 107 patients (8.6%) were lost to follow-up and excluded. The primary outcome was the long-term incidence of ischemic cerebrovascular events (ie, ischemic stroke, excluding transient ischemic attack) and all-cause mortality.

RESULTS

Of the 1136 patients, 37 (3.3%) had ischemic cerebrovascular events. The 1-year, 5-year, and 10-year freedoms from long-term ischemic cerebrovascular events of the left atrial appendage extracardiac ligation group were 99.7%, 94.0%, and 90.8%, respectively. The 1-year, 5-year, and 10-year survivals of the left atrial appendage intracardiac suture group were 99.7%, 94.6%, and 93.6%, respectively. There was a significant difference between the left atrial appendage extracardiac ligation group and the left atrial appendage excision group (P = .041). Seventeen patients (4.6%) had long-term ischemic cerebrovascular events in the left atrial appendage extracardiac ligation group (1.1% per year), 14 patients (3.5%) in the left atrial appendage intracardiac suture group (0.9% per year), and 6 patients (1.7%) in the left atrial appendage excision group (0.44% per year). Left atrial appendage excision can reduce the occurrence of long-term thrombotic stroke compared with left atrial appendage extracardiac ligation (95% confidence interval, 1.09-9.26; P = .035).

CONCLUSIONS

For patients with atrial fibrillation, the removal of the left atrial appendage can effectively prevent stroke caused by atrial fibrillation.