Gerçek Mustafa, Skuljevic Tomislav, Börgermann Jochen, Gummert Jan, Gerçek Muhammed
Clinic for Cardiac Surgery and Pediatric Cardiac Surgery, Heart Center Duisburg, Gerrickstraße 21, 47137, Duisburg, Germany.
Clinic for Thoracic and Cardiovascular Surgery, Herz- Und Diabeteszentrum NRW, Georgstraße 11, 32545, Bad Oeynhausen, Germany.
Clin Res Cardiol. 2024 Sep 2. doi: 10.1007/s00392-024-02529-9.
Left atrial appendage (LAA) amputation performed alongside cardiac surgery has become an increasingly established procedure to reduce stroke risk in patients with atrial fibrillation. As the recommendation levels for LAA amputation continue to rise, ample evidence assessing its perioperative safety and risk factors is of utmost interest.
All patients who underwent isolated coronary artery bypass grafting (CABG) between 2018 and 2021 at two high-volume centers were retrospectively included in the study. Patients were divided into two groups-the CABG and CABG + LAA groups-based on whether they underwent concomitant LAA amputation. Propensity score matching (PS matching) was applied to ensure comparability between the groups. The primary endpoint was defined as a composite outcome comprising of all-cause mortality, stroke, and reoperation. Secondary endpoints included the components of the primary endpoint, perioperative outcome parameters, transfusion rates, and laboratory parameters.
A total of 3904 patients were included with 3038 and 866 in the CABG and CABG + LAA group, respectively. After PS matching each group consisted of 856 patients. The primary endpoint showed no significant differences between the CABG and CABG + LAA group (7.0% vs. 6.5% (OR 0.9 95% CI [0.64; 1.35], p = 0.70)). Similarly, there were no notable differences in the individual components of the composite endpoint: all-cause mortality (p = 0.84), stroke (p = 0.74), and reoperation (p = 0.50). Subgroup results did not show any relevant dissimilarity.
The concomitant performance of LAA amputation is not associated with worse in-hospital outcomes, as measured by the composite endpoint of all-cause mortality, stroke, and reoperation.
在心脏手术的同时进行左心耳（LAA）切除术已成为降低房颤患者中风风险的一种越来越成熟的手术。随着LAA切除术的推荐级别不断提高，评估其围手术期安全性和风险因素的充分证据备受关注。
回顾性纳入2018年至2021年在两个大型中心接受单纯冠状动脉旁路移植术（CABG）的所有患者。根据患者是否同时接受LAA切除术，将患者分为两组——CABG组和CABG+LAA组。应用倾向评分匹配（PS匹配）以确保两组之间具有可比性。主要终点定义为包括全因死亡率、中风和再次手术的复合结局。次要终点包括主要终点的组成部分、围手术期结局参数、输血率和实验室参数。
共纳入3904例患者，CABG组和CABG+LAA组分别有3038例和866例。PS匹配后，每组各有856例患者。主要终点在CABG组和CABG+LAA组之间无显著差异（7.0%对6.5%（OR 0.9，95%CI[0.64；1.35]，p=0.70））。同样，复合终点的各个组成部分也无显著差异：全因死亡率（p=0.84）、中风（p=0.74）和再次手术（p=0.50）。亚组结果未显示任何相关差异。
以全因死亡率、中风和再次手术的复合终点衡量，同时进行LAA切除术与更差的院内结局无关。
