不停跳冠状动脉旁路移植术后左心耳切除对左心房形态和节律的影响。

Impact of Left Atrial Appendage Amputation on Left Atrial Morphology and Rhythm after Off-Pump CABG.

机构信息

Herz-und Diabeteszentrum NRW, Clinic for General and Interventional Cardiology/Angiology, Bad Oeynhausen, Germany.

Herz- und Diabeteszentrum NRW, Clinic for Thoracic and Cardiovascular Surgery, Bad Oeynhausen, Germany.

出版信息

Thorac Cardiovasc Surg. 2023 Jun;71(4):273-281. doi: 10.1055/s-0041-1735809. Epub 2021 Nov 22.

DOI:10.1055/s-0041-1735809

PMID:34808680

Abstract

OBJECTIVES

Left atrial appendage (LAA) amputation concomitant to coronary artery bypass grafting (CABG) has become an increasingly performed technique in patients with atrial fibrillation (AF) or with sinus rhythm and a CHA2DS2-VASc score ≥2. However, LAA amputation has come under suspicion to cause postoperative atrial fibrillation (POAF) due to left atrial (LA) dilation. This study aims to assess this assumption in patients undergoing CABG in off-pump technique with and without amputation of the LAA.

METHODS

Patients who underwent isolated CABG in off-pump technique without history of AF were retrospectively examined. Cohorts were divided according to the concomitant execution of LAA amputation. LA volume was measured by transthoracic echocardiography and rhythm was analyzed by electrocardiography, medication protocol, and visit documentation. Propensity score (PS) matching was performed based on 20 preoperative risk variables to correct for selection bias.

RESULTS

A total of 1,522 patients were enrolled, with 1,267 in the control group and 255 in the LAA amputation group. Occurrence of POAF was compared in 243 PS-matched patient pairs. Neither the unmatched cohort (odds ratio [OR] 0.82; 95% confidence interval or CI [0.61; 1.11], = 0.19) nor the PS-matched cohort (OR 0.94; 95% CI [0.62; 1.41], = 0.75) showed significant differences in POAF occurrence. Subgroup analysis of sex, use of β-blockers, pulmonary disease, ejection fraction, and CHA2DS2-VASc-Score also showed no tendencies. LA volume did not change significantly ( = 0.18, 95% CI [-0.29; 1.51]).

CONCLUSION

Surgical amputation of the LAA concomitant to CABG did not lead to LA dilation and has no significant impact on the occurrence of POAF.

摘要

目的

左心耳（LAA）切除术与冠状动脉旁路移植术（CABG）联合应用于伴有心房颤动（AF）或窦性心律且 CHA2DS2-VASc 评分≥2 的患者，已成为一种越来越常用的技术。然而，由于左心房（LA）扩张，LAA 切除术导致术后心房颤动（POAF）的可能性受到质疑。本研究旨在评估在非体外循环技术下行 CABG 手术且不伴有 LAA 切除的患者中，这一假设是否成立。

方法

回顾性分析了既往无 AF 病史、接受非体外循环下孤立 CABG 术的患者。根据 LAA 切除术的施行情况将患者分为两组。通过经胸超声心动图测量左房容积，通过心电图、药物治疗方案和就诊记录分析节律。根据 20 项术前风险变量进行倾向评分（PS）匹配，以纠正选择偏倚。

结果

共纳入 1522 例患者，其中对照组 1267 例，LAA 切除组 255 例。比较了 243 对 PS 匹配患者的 POAF 发生率。未匹配队列（比值比 [OR] 0.82；95%置信区间 [0.61；1.11]， = 0.19）和 PS 匹配队列（OR 0.94；95%置信区间 [0.62；1.41]， = 0.75）的 POAF 发生率均无显著差异。性别、β受体阻滞剂使用、肺部疾病、射血分数和 CHA2DS2-VASc 评分亚组分析也未显示出趋势。左房容积无明显变化（ = 0.18，95%置信区间[-0.29；1.51]）。