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Left atrial appendage amputation for atrial fibrillation during aortic valve replacement
ID Kališnik, Jurij-Matija (Author), ID Santarpino, Giuseppe (Author), ID Balbierer, Andrea (Author), ID Žibert, Janez (Author), ID Vogt, Ferdinand (Author), ID Fittkau, Matthias (Author), ID Fischlein, Theodor (Author)

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Abstract
Background. Occluding the left atrial appendage (LAA) during cardiac surgery reduces the risk of ischemic stroke; nonetheless, it is currently only softly recommended with “may be considered” by the current guidelines. We aimed to assess thromboembolic risk after LAA amputation in patients with atrial fibrillation (AF) and aortic stenosis undergoing biological aortic valve replacement (AVR) as primary cardiac surgery. Methods. Two cohorts were generated retrospectively: patients with AF undergoing AVR alone or combined with revascularization either with LAA amputation or without. Data were collected from the hospital-specific data system. Follow-up was completed by telephone interview or in person. Thirty-day and follow-up results were compared in patients with vs. without LAA amputation. Results. One hundred and fifty-seven patients were investigated retrospectively, and seventy-four pairs were matched with regard to baseline characteristics. Patients with LAA amputation exhibited a lower incidence of cumulative and late ischemic stroke (6.4% vs. 25%, p = 0.028 and 3.2% vs. 20%, p = 0.008, respectively; hazard ratio 0.30; 95% confidence interval 0.11; 0.84; p = 0.021) during follow-up of 48 months vs. patients without intervention during follow-up of 45 months, p = 0.494. No significant differences were observed in postoperative stroke, 2 (2.7%) vs. 3 (4.1%), p = 1.000, re-exploration for bleeding 3 (4.1%) vs. 6 (8.1), p = 0.494 or late pericardial effusion 2 (2.7%) vs. 3 (4.1%), p = 1.000, in-hospital 2 (2.7%) vs. 4 (5.4%), p = 0.681 and all-cause mortality 15 (23.8%) vs. 9 (15%), p = 0.315 in patients with vs. without LAA amputation, respectively. Conclusions. A combination of leading aortic stenosis and AF in patients undergoing isolated or combined biological AVR represents a subpopulation with excessive thromboembolic risk. Concomitant LAA amputation during cardiac surgery reduces the risk of ischemic stroke without posing an additional periprocedural risk for the patient. Therefore, the minimal invasive approach at the expense of omitting LAA amputation should be discouraged to maximize the clinical benefits of AVR in this setting.

Language:English
Keywords:ischemic stroke, atrial fibrillation, left atrial amputation, aortic valve replacement
Work type:Article
Typology:1.01 - Original Scientific Article
Organization:ZF - Faculty of Health Sciences
MF - Faculty of Medicine
Publication status:Published
Publication version:Version of Record
Publication date:01.01.2022
Year:2022
Number of pages:12 str.
Numbering:Vol. 11, iss. 12, art. 3408
PID:20.500.12556/RUL-138067 This link opens in a new window
UDC:616.12:616.831-005.1
ISSN on article:2077-0383
DOI:10.3390/jcm11123408 This link opens in a new window
COBISS.SI-ID:114791939 This link opens in a new window
Publication date in RUL:08.07.2022
Views:1194
Downloads:100
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Record is a part of a journal

Title:Journal of clinical medicine
Shortened title:J. clin. med.
Publisher:MDPI
ISSN:2077-0383
COBISS.SI-ID:5405759 This link opens in a new window

Licences

License:CC BY 4.0, Creative Commons Attribution 4.0 International
Link:http://creativecommons.org/licenses/by/4.0/
Description:This is the standard Creative Commons license that gives others maximum freedom to do what they want with the work as long as they credit the author.
Licensing start date:08.07.2022

Secondary language

Language:Undetermined
Keywords:ishemična možganska kap, atrijska fibrilacija, amputacija levega atrija, zamenjava aortne zaklopke

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