Division of Cardiology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Keimyung University Dongsan Hospital, Daegu, Republic of Korea.
Sci Rep. 2024 Oct 4;14(1):23063. doi: 10.1038/s41598-024-73400-0.
Surgical occlusion of the left atrial appendage (LAA) during cardiac surgery in patients with atrial fibrillation (AF) is known to reduce thromboembolism. However, data on the clinical significance of LAA occlusion (LAAO) in patients with mitral regurgitation (MR) are lacking. A total of 237 AF patients with chronic severe MR who underwent mitral valve (MV) surgery were retrospectively analyzed. Patients were divided into two groups according to concomitant LAAO or LAA preservation. The primary outcome was a composite of all-cause death and thromboembolic events (ischemic stroke or systemic embolism). The LAA was surgically occluded in 98 (41%) patients and preserved in 139 (59%) patients. During the follow-up period (median, 37 months), 29 primary outcomes occurred. In the Kaplan-Meyer analysis, the LAA preservation group showed a greater cumulative incidence of the primary outcome (P = 0.002) and thromboembolic events (P = 0.003) than the LAAO group. In the univariate Cox regression analysis, coronary artery disease, CHADS-VASc score, a cauliflower-shaped LAA, Maze, and no LAAO were significantly associated with the primary outcome. In the multivariate Cox regression analysis, concomitant LAAO was significantly linked to the primary outcome (hazard ratio [HR]: 0.30, 95% confidence interval [CI]: 0.10-0.91, P = 0.033) and thromboembolic events (HR: 0.19, 95% CI: 0.04-0.87, P = 0.032). These benefits from LAAO were consistent, even after propensity score-matched analysis. For patients undergoing surgery for chronic MR who also have AF, concomitant surgical LAAO is associated with favorable clinical outcome.
在心脏手术中对心房颤动（AF）患者的左心耳（LAA）进行外科闭塞已知可减少血栓栓塞。然而，缺乏关于 LAA 闭塞（LAAO）在二尖瓣反流（MR）患者中的临床意义的数据。回顾性分析了 237 例患有慢性重度 MR 的 AF 患者，这些患者均接受了二尖瓣（MV）手术。根据 LAAO 或 LAA 保留情况将患者分为两组。主要结局是全因死亡和血栓栓塞事件（缺血性中风或全身性栓塞）的复合事件。237 例患者中有 98 例（41％）进行了 LAA 外科闭塞，139 例（59％）保留了 LAA。在随访期间（中位数 37 个月），发生了 29 个主要结局。在 Kaplan-Meier 分析中，LAA 保留组的主要结局（P=0.002）和血栓栓塞事件（P=0.003）的累积发生率更高。在单变量 Cox 回归分析中，冠状动脉疾病，CHA2DS2-VASc 评分，菜花状 LAA，迷宫手术和不进行 LAAO 与主要结局显著相关。在多变量 Cox 回归分析中，同时进行 LAAO 与主要结局（危险比[HR]：0.30，95％置信区间[CI]：0.10-0.91，P=0.033）和血栓栓塞事件（HR：0.19，95％CI：0.04-0.87，P=0.032）显著相关。即使在倾向评分匹配分析后，LAAO 也能带来这些益处。对于同时患有 AF 和慢性 MR 而接受手术的患者，同时进行外科 LAAO 与良好的临床结局相关。
