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Left atrial appendage amputation for atrial fibrillation during aortic valve replacement
ID
Kališnik, Jurij-Matija
(
Avtor
),
ID
Santarpino, Giuseppe
(
Avtor
),
ID
Balbierer, Andrea
(
Avtor
),
ID
Žibert, Janez
(
Avtor
),
ID
Vogt, Ferdinand
(
Avtor
),
ID
Fittkau, Matthias
(
Avtor
),
ID
Fischlein, Theodor
(
Avtor
)
PDF - Predstavitvena datoteka,
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(1,34 MB)
MD5: 44AE874DD0B548CEFB13DDFA6A8FE8DF
URL - Izvorni URL, za dostop obiščite
https://www.mdpi.com/2077-0383/11/12/3408/htm
Galerija slik
Izvleček
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.
Jezik:
Angleški jezik
Ključne besede:
ischemic stroke
,
atrial fibrillation
,
left atrial amputation
,
aortic valve replacement
Vrsta gradiva:
Članek v reviji
Tipologija:
1.01 - Izvirni znanstveni članek
Organizacija:
ZF - Zdravstvena fakulteta
MF - Medicinska fakulteta
Status publikacije:
Objavljeno
Različica publikacije:
Objavljena publikacija
Datum objave:
01.01.2022
Leto izida:
2022
Št. strani:
12 str.
Številčenje:
Vol. 11, iss. 12, art. 3408
PID:
20.500.12556/RUL-138067
UDK:
616.12:616.831-005.1
ISSN pri članku:
2077-0383
DOI:
10.3390/jcm11123408
COBISS.SI-ID:
114791939
Datum objave v RUL:
08.07.2022
Število ogledov:
986
Število prenosov:
78
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Objavi na:
Gradivo je del revije
Naslov:
Journal of clinical medicine
Skrajšan naslov:
J. clin. med.
Založnik:
MDPI
ISSN:
2077-0383
COBISS.SI-ID:
5405759
Licence
Licenca:
CC BY 4.0, Creative Commons Priznanje avtorstva 4.0 Mednarodna
Povezava:
http://creativecommons.org/licenses/by/4.0/deed.sl
Opis:
To je standardna licenca Creative Commons, ki daje uporabnikom največ možnosti za nadaljnjo uporabo dela, pri čemer morajo navesti avtorja.
Začetek licenciranja:
08.07.2022
Sekundarni jezik
Jezik:
Ni določen
Ključne besede:
ishemična možganska kap
,
atrijska fibrilacija
,
amputacija levega atrija
,
zamenjava aortne zaklopke
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