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The impact of surgical left atrial appendage amputation/ligation on stroke prevention in patients undergoing off-pump coronary artery bypass grafting

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Abstract

Stroke is a major adverse event in patients developing atrial fibrillation (AF) after cardiac surgery. Surgical left atrial appendage amputation/ligation (LAA-A/L) during off-pump coronary artery bypass grafting (OPCAB) is routinely performed in our institution. We analyzed 578 consecutive patients (mean age 69 years, male 82%) undergoing OPCAB with or without concomitant LAA-A/L from 2011 to 2014 at our institution in a prospective observational manner. The safety and efficacy of the concomitant LAA-A/L on preventing early (<30 days) and overall postoperative stroke were examined. A total of 193 patients (33.4%) underwent LAA-A/L, consisting of amputation in 154 and ligation in 39 patients (80 and 20% of the cases, respectively). Preoperative characteristics, operative time, requirement of blood transfusion, and 30-day mortality were not significantly different between those with and without LAA-A/L. The incidences of postoperative AF and early and overall stroke were not significantly different between the groups in the analysis based on a total cohort. In a subanalysis of patients without LAA-A/L, early and overall stroke occurred more frequently in those developing postoperative AF than those without AF (2.8 vs. 0%; p = 0.005, 6.2 vs. 1.5%; p = 0.017, respectively), while in patients receiving LAA-A/L, stroke incidences did not differ between those with and without AF. Multivariate logistic regression showed postoperative AF without LAA-A/L as the only independent positive predictor of overall stroke (OR 3.69, p = 0.03). Concomitant LAA-A/L with OPCAB can safely prevent postoperative stroke occurrence in case patients develop AF, the most common arrhythmia associated with stroke.

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Acknowledgements

This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation. The authors had full control over the study design, methods used, outcome parameters and results, analysis of data, and production of the written report. This study was funded without assistance from industrial sources. None of the authors received additional funds or aid related to or as a consequence of this study. We thank Dr. Yamamoto, Dr. Shimada, Dr. Kajimoto for their cooperation. We thank Mr. Sugimoto (Sugimoto Data Analysis Service) for his statistical review of the manuscript.

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    1. Department of Cardiovascular Surgery, Heart Center, Juntendo University School of Medicine, Building 9, 1F-Room124A, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan

      Daisuke Endo, Tomoko S. Kato, Tai Iwamura, Atsumi Oishi, Yasutaka Yokoyama, Kenji Kuwaki, Hirotaka Inaba & Atsushi Amano

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    1. Daisuke Endo
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    Correspondence to Tomoko S. Kato.

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    D. Endo and T. S. Kato contributed equally to this work.

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    Endo, D., Kato, T.S., Iwamura, T. et al. The impact of surgical left atrial appendage amputation/ligation on stroke prevention in patients undergoing off-pump coronary artery bypass grafting. Heart Vessels 32, 726–734 (2017). https://doi.org/10.1007/s00380-016-0915-x

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