Awad Ahmed K, Elbahloul Mohammed A, Gamal Aliaa, Attia Amir N, Hamed Sarah M, Elsekhary Ahmed I, Sá Michel Pompeu
Faculty of Medicine, Ain-Shams University, Cairo, Egypt; Department of Cardiothoracic Surgery, Ain-Shams University Hospitals, Cairo, Egypt.
Faculty of Medicine, Kafr El-Shaikh University, Kafr El-Shaikh, Egypt.
J Cardiol. 2025 Mar;85(3):177-185. doi: 10.1016/j.jjcc.2025.01.011. Epub 2025 Jan 28.
Atrial fibrillation (AF) is a prevalent cardiac arrhythmia that greatly elevates the risk of stroke. This risk increases both during and after cardiac procedures, such as coronary artery bypass grafting (CABG). There is an increasing interest in non-pharmacological treatments such as left atrial appendage occlusion (LAAO) and surgical ablation, intending to enhance both immediate and long-term postoperative results.
To investigate the efficacy of surgical ablation (SA), LAAO, or both in patients with AF undergoing CABG.
We searched four electronic databases: PubMed, Scopus, Cochrane Library, and WOS. We analyzed data using R language and "netmeta" and "netrank" packages of meta-insight software. Pooled outcomes were reported as mean difference or risk ratio (RR) with 95 % confidence interval (CI) in a random effect method.
A total of 16 studies were included with 594,312 patients included. The 30-day mortality showed a non-statistically significant difference between CABG-LAAO compared to CABG alone and CABG-SA with RR of 1.70 (95%CI 0.38-7.61) and 0.62 (95%CI 0.10-3.94). However, compared to CABG alone, CABG-SA + LAAO, CABG-LAAO, and CABG-SA had significantly lower risk of long-term mortality with RR 0.75 (95%CI 0.57-0.98), 0.78 (95%CI 0.65-0.94), and 0.73 (95%CI 0.61-0.88), respectively. CABG-SA + LAAO, CABG-LAAO, and CABG-SA reduced the risk of short-term stroke compared to CABG alone with RR of 0.73 (95%CI 0.43-1.24), 0.93 (95%CI 0.78-1.11), and 1.01 (95%CI 0.75-1.36), respectively. Moreover, only CABG-SA + LAAO and CABG-LAAO showed a statistically significant reduction in long term stroke and hospitalization due to heart failure while CABG-SA showed no statistically significant difference. Furthermore, there was no statistically significant difference between our interventions in terms of 30-day rehospitalization, intra-aortic balloon pump support, and risk of hemorrhage.
Among patients with AF undergoing CABG, whether undergoing SA alone or LAAO alone or both showed significant clinical outcomes such as reduced risk of both short- and long-term mortality and short-term stroke.
心房颤动（AF）是一种常见的心律失常，会显著增加中风风险。在诸如冠状动脉旁路移植术（CABG）等心脏手术期间及术后，这种风险都会增加。人们对诸如左心耳封堵术（LAAO）和外科消融术等非药物治疗的兴趣日益浓厚，旨在改善术后即刻及长期效果。
探讨外科消融术（SA）、左心耳封堵术（LAAO）或两者联合应用于接受CABG的房颤患者的疗效。
我们检索了四个电子数据库：PubMed、Scopus、Cochrane图书馆和WOS。我们使用R语言以及meta-insight软件的“netmeta”和“netrank”包对数据进行分析。汇总结果以随机效应模型中的均值差或风险比（RR）及95%置信区间（CI）报告。
共纳入16项研究，涉及594312例患者。与单纯CABG相比，CABG-LAAO组和CABG-SA组的30天死亡率无统计学显著差异，RR分别为1.70（95%CI 0.38 - 7.61）和0.62（95%CI 0.10 - 3.94）。然而，与单纯CABG相比，CABG-SA + LAAO组、CABG-LAAO组和CABG-SA组的长期死亡风险显著降低，RR分别为0.75（95%CI 0.57 - 0.98）、0.78（95%CI 0.65 - 0.94）和0.73（95%CI 0.61 - 0.88）。与单纯CABG相比，CABG-SA + LAAO组、CABG-LAAO组和CABG-SA组的短期中风风险降低，RR分别为0.73（95%CI 0.43 - 1.24）、0.93（95%CI 0.78 - 1.11）和1.01（95%CI 0.75 - 1.36）。此外，只有CABG-SA + LAAO组和CABG-LAAO组在长期中风和因心力衰竭住院方面有统计学显著降低，而CABG-SA组无统计学显著差异。此外，在30天再住院、主动脉内球囊泵支持和出血风险方面，我们的干预措施之间无统计学显著差异。
在接受CABG的房颤患者中，无论是单独进行SA还是LAAO或两者联合应用，都显示出显著的临床效果，如降低短期和长期死亡风险以及短期中风风险。
