Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Heart. 2022 Nov 10;108(23):1864-1872. doi: 10.1136/heartjnl-2022-320939.
There is limited evidence regarding the effectiveness of left atrial appendage (LAA) closure during surgical ablation of atrial fibrillation (AF) in yielding superior clinical outcomes. This study aimed to evaluate the association of LAA closure versus preservation with the risk of adverse clinical outcomes among patients undergoing surgical ablation during cardiac surgery.
We evaluated 1640 patients (aged 58.8±11.5 years, 898 women) undergoing surgical ablation during cardiac surgery (including mitral valve (MV), n=1378; non-MV, n=262) between 2001 and 2018. Of these, 804 had LAA preserved, and the remaining 836 underwent LAA closure. Comparative risks of stroke and mortality between the two groups were evaluated after adjustments with inverse-probability-of-treatment weighting (IPTW). Longitudinal echocardiographic data (n=9674, 5.9/patient) on transmitral A-wave and E/A-wave ratio were analysed by random coefficient models.
Adjustment with IPTW yielded patient cohorts well-balanced for baseline profiles. During a median follow-up of 43.5 months (IQR 19.0-87.3 months), stroke and death occurred in 87 and 249 patients, respectively. The adjusted risk of stroke (HR 0.85; 95% CI 0.52-1.39) and mortality (HR 0.80; 95% CI 0.61 to 1.05) did not differ significantly between the two groups. Echocardiographic data demonstrated higher transmitral A-wave velocity (group-year interaction, p=0.066) and lower E/A-wave ratio (group-year interaction, p=0.045) in the preservation group than in the closure group.
LAA preservation during surgical AF ablation was not associated with an increased risk of stroke or mortality. Postoperative LA transport functions were more favourable with LAA preservation than with LAA closure.
在心脏手术中进行房颤（AF）消融术时，左心耳（LAA）封堵的有效性在产生更好的临床结果方面的证据有限。本研究旨在评估在心脏手术中进行消融术时，与 LAA 保留相比，LAA 封堵与不良临床结果风险之间的关联。
我们评估了 1640 名（年龄 58.8±11.5 岁，898 名女性）在 2001 年至 2018 年间接受心脏手术中消融术的患者（包括二尖瓣（MV），n=1378；非 MV，n=262）。其中 804 例患者保留 LAA，其余 836 例患者接受 LAA 封堵。在进行逆概率治疗加权（IPTW）调整后，评估两组之间中风和死亡率的风险比。通过随机系数模型分析经胸 M 型超声心动图的跨二尖瓣 A 波和 E/A 波比值的纵向超声心动图数据（n=9674，5.9/患者）。
使用 IPTW 进行调整后，患者队列在基线特征方面得到很好的平衡。在中位数为 43.5 个月（IQR 19.0-87.3 个月）的随访期间，分别有 87 例和 249 例患者发生中风和死亡。调整后的中风风险（HR 0.85；95%CI 0.52-1.39）和死亡率（HR 0.80；95%CI 0.61 至 1.05）在两组之间无显著差异。超声心动图数据显示，与 LAA 封堵组相比，LAA 保留组的跨二尖瓣 A 波速度更高（组年交互作用，p=0.066），E/A 波比值更低（组年交互作用，p=0.045）。
在心脏手术中进行房颤消融术时，保留 LAA 并不增加中风或死亡率的风险。与 LAA 封堵相比，LAA 保留术后左房传输功能更有利。
