Abstract TP409: Impact of Surgical Ligation of the Left Atrial Appendage at the Time of Cardiac Surgery: A Propensity-Matched Analysis of Post-Operative Complications, Stroke, and 30-Day Mortality in 1,204 Patients
Background: The left atrial appendage (LAA) is the source of 90% of thrombi in patients with atrial fibrillation. Our technique of doubly ligating the LAA (LLAA) has recently demonstrated a 95% success rate of achieving complete LAA occlusion by follow-up transesophageal echocardiography. However, the outcomes of these patients have yet to be compared to a set of non-ligated patients.
Methods: From 2005 to 2012, 814 patients received LLAA using our previously published technique of double ligation with both a PDS II endosnare and a running 4-0 Prolene pledgeted suture. Propensity scores were developed based on 22 observed baseline covariates in a logistic regression model with LLAA as the dependent variable. This produced two patient cohorts of 602 patients balanced for baseline factors. These patients were retrospectively analyzed regarding their incidence of 30-day outcomes.
Results: Overall, the ligated group had a higher rate of comorbidities, shorter ICU and post-surgical length of stay, less post-operative bleeding, lower rate of permanent stroke, and an overall significantly lower in-hospital mortality (0.7% vs. 3.0% p<0.001) and lower 30-day mortality (0.7% vs. 3.4%; p<0.0001). After propensity matching, post-operative myocardial infarction, stroke, atrial fibrillation, re-operation, and complications rates were similar between the two cohorts. There still was a statistically significant difference in mortality, with the ligated group having lower in-hospital (0.8% vs. 2.3% p=0.037) and 30-day mortality (0.8% vs. 2.8% p=0.01)
Conclusions: Propensity matched analysis demonstrates that LLAA correlates with lower rates of in-hospital and 30-day mortality. This advantage comes without an increase in intraoperative or postoperative complications. This technique can easily be performed off or on pump, is very reproducible, and comes at a very low cost compared to LAA occlusion devices. Stroke has a multifactorial etiology; successful LLAA removes one potential source of thrombi peri-operatively and in the long term.
- © 2012 by American Heart Association, Inc.