Division of Cardiac Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.
Population Health Research Institute, 237 Barton Street E, Hamilton, ON, L8L 2X2, Canada.
Curr Cardiol Rep. 2022 Jul;24(7):823-828. doi: 10.1007/s11886-022-01705-5. Epub 2022 Apr 30.
In this review, we discuss some of the observational studies that examined the impact of left atrial appendage occlusion on stroke, the Left Atrial Appendage Occlusion Study (LAAOS) III research program that provided definitive evidence for the benefit of surgical left atrial appendage occlusion on ischemic stroke, and high priority studies in the field that should be pursued by the surgical community.
Atrial fibrillation is common in patients undergoing cardiac surgery. Oral anticoagulants are effective at preventing strokes related to atrial fibrillation; they have been the standard of care for stroke prevention in patients with atrial fibrillation for decades. Most strokes in patients with atrial fibrillation originate from the left atrial appendage. LAAOS III, a large randomized controlled trial, has recently demonstrated that concomitant left atrial appendage occlusion in patients undergoing cardiac surgery for another indication reduces the risk of stroke or systemic embolism on top of oral anticoagulation. Surgical left atrial appendage occlusion reduces the risk of ischemic stroke and systemic embolism in patients with atrial fibrillation and a CHADS-VASc score ≥ 2 undergoing cardiac surgery for another indication. The role of surgical left atrial appendage occlusion with patients without atrial fibrillation, as a substitute to anticoagulation and as a standalone procedure, remains unclear.
在这篇综述中，我们讨论了一些观察性研究，这些研究探讨了左心耳封堵术对卒中的影响、提供了确凿证据表明手术左心耳封堵术对缺血性卒中有获益的左心耳封堵术研究 (LAAOS) III 研究项目，以及该领域应得到外科界关注的重点研究。
心房颤动在接受心脏手术的患者中很常见。口服抗凝剂在预防与心房颤动相关的卒中方面是有效的；几十年来，它们一直是心房颤动患者卒中预防的标准治疗方法。大多数心房颤动患者的卒中源自左心耳。最近的一项大型随机对照试验 LAAOS III 表明，对于因其他适应证而接受心脏手术的患者，在口服抗凝治疗的基础上同时进行左心耳封堵术，可降低卒中或全身性栓塞的风险。对于因其他适应证而接受心脏手术的伴有心房颤动和 CHADS-VASc 评分≥2 的患者，手术左心耳封堵术可降低缺血性卒中和全身性栓塞的风险。对于无心房颤动的患者，手术左心耳封堵术作为抗凝治疗的替代方法以及作为单独的治疗方法的作用尚不清楚。
