Kiankhooy Armin, Sertic Federico, Daw Michaela, Eisenberg Susan, Kiankhooy Arash, Dunnington Gansevoort
Department of Cardiothoracic Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
Department of Cardiothoracic Surgery, Adventist Health-St Helena Hospital, St Helena, California.
Ann Thorac Surg Short Rep. 2023 Sep 27;2(1):25-29. doi: 10.1016/j.atssr.2023.09.007. eCollection 2024 Mar.
Postoperative atrial fibrillation (POAF) is common after cardiac operations, and effective intraoperative techniques aimed at reducing POAF focus on limiting left atrial triggers through posterior pericardiotomy or pulmonary vein isolation. Prophylactic left atrial appendage occlusion (LAAO) is increasingly used in hopes of preventing POAF-associated strokes. We sought to compare the incidence of POAF in patients undergoing prophylactic LAAO with or without a prophylactic non-atriotomy surgical ablation (NASA).
A retrospective observational cohort comparison study of patients undergoing first-time isolated coronary artery bypass grafting (CABG) with LAAO only (n = 90) or NASA+LAAO (n = 42) was conducted from July 2020 through November 2022. In-hospital POAF was defined by standard Society of Thoracic Surgeons (STS) definitions using 24-hour continuous telemetry and daily electrograms. Standard STS outcomes were also examined. Data are represented as mean ± SD. values <.05 are considered significant.
STS-collected patient demographics, operative characteristics, and major complications did not differ significantly between cohorts. The rate of POAF (LAAO only, 41.1%; NASA+LAAO, 4.7%; < .0001; odds ratio, 0.07; 95% CI, 0.016-0.27) and amiodarone on discharge (LAAO only, 42.5%; NASA+LAAO, 7.3%; < .0001; odds ratio, 0.11; 95% CI, 0.03-0.33) differed significantly between cohorts. Total hospital costs were similar.
In patients with isolated coronary artery bypass grafting undergoing LAAO, a NASA is associated with a reduction of in-hospital POAF and need for antiarrhythmic medications on discharge. Future randomized prospective controlled studies are needed to prove safety and effectiveness.
心脏手术后，术后房颤（POAF）很常见，旨在减少POAF的有效术中技术侧重于通过心包后切开术或肺静脉隔离来限制左心房触发因素。预防性左心耳封堵术（LAAO）越来越多地被用于预防与POAF相关的中风。我们试图比较接受预防性LAAO且行或不行预防性非心房切开术式手术消融（NASA）的患者中POAF的发生率。
对2020年7月至2022年11月期间首次接受单纯冠状动脉旁路移植术（CABG）且仅行LAAO（n = 90）或NASA + LAAO（n = 42）的患者进行回顾性观察队列比较研究。采用标准的胸外科医师协会（STS）定义，通过24小时连续遥测和每日心电图来定义院内POAF。还检查了标准的STS结局。数据以平均值±标准差表示。P值<0.05被认为具有统计学意义。
STS收集的患者人口统计学、手术特征和主要并发症在各队列之间无显著差异。POAF发生率（仅LAAO组为41.1%；NASA + LAAO组为4.7%；P < 0.0001；优势比为0.07；95%置信区间为0.016 - 0.27）和出院时胺碘酮使用情况（仅LAAO组为42.5%；NASA + LAAO组为7.3%；P < 0.0001；优势比为0.11；95%置信区间为0.03 - 0.33）在各队列之间存在显著差异。总住院费用相似。
在接受LAAO的单纯冠状动脉旁路移植术患者中，NASA与院内POAF的减少以及出院时抗心律失常药物需求的降低相关。未来需要进行随机前瞻性对照研究以证明其安全性和有效性。
