Association between incomplete surgical ligation of left atrial appendage and stroke and systemic embolization.

Autor:	Aryana A; Regional Cardiology Associates, Sacramento, California; Dignity Health Heart and Vascular Institute, Sacramento, California. Electronic address: aaryana@rcamd.com., Singh SK; Department of Cardiothoracic Surgery, CHI Baylor St. Luke's Medical Center, Texas Heart Institute, Houston, Texas., Singh SM; Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada., O'Neill PG; Regional Cardiology Associates, Sacramento, California; Dignity Health Heart and Vascular Institute, Sacramento, California., Bowers MR; Regional Cardiology Associates, Sacramento, California; Dignity Health Heart and Vascular Institute, Sacramento, California., Allen SL; Regional Cardiology Associates, Sacramento, California., Lewandowski SL; Regional Cardiology Associates, Sacramento, California., Vierra EC; Regional Cardiology Associates, Sacramento, California., d'Avila A; Instituto de Pesquisa em Arritmia Cardiaca, Hospital Cardiologico-Florianopolis, Florianopolis, Santa Catarina, Brazil.
Jazyk:	angličtina
Zdroj:	Heart rhythm [Heart Rhythm] 2015 Jul; Vol. 12 (7), pp. 1431-7. Date of Electronic Publication: 2015 May 18.
DOI:	10.1016/j.hrthm.2015.03.028
Abstrakt:	Background: Surgical exclusion of the left atrial appendage (LAA) can frequently yield incomplete closure. Objective: We evaluated the ischemic stroke/systemic embolization (SSE) risk in patients with atrial fibrillation (AF) and complete LAA closure (cLAA) vs incompletely surgically ligated LAA (ISLL) and LAA stump after surgical suture ligation. Methods: Seventy-two patients (CHA2DS2-VASc score 4.1 ± 1.9) underwent surgical LAA ligation in conjunction with mitral valve/AF surgery and postoperative LAA evaluation using computerized tomographic angiography. Results: Overall, cLAA was detected in 46 of 72 patients (64%), ISLL in 17 patients (24%), and LAA stump in 9 patients (12%). The incidences of oral anticoagulation (OAC) and recurrent AF were similar among the 3 groups during 44 ± 19 months of follow-up. SSE occurred in 2% of patients with cLAA vs 24% with ISLL and 0% with LAA stump (P = .006). None of the patients with SSE were receiving OAC, and all had recurrent AF during follow-up. Additionally, patients with SSE exhibited a significantly smaller ISLL neck diameter (2.8 ± 1.0 vs 7.1 ± 2.1 mm; P = .002). The annualized SSE risk was 1.9% (entire cohort), 6.5% (ISLL patients), 14.4% (ISLL patients not receiving OAC), and 19.0% (ISLL neck diameter ≤5.0 mm) per 100 patient-years of follow-up. The latter risk was nearly 5 times greater than predicted by conventional risk-stratification schemes. Moreover, ISLL emerged as an independent predictor of SSE in univariate analyses and as the sole predictor of SSE in a multivariate analysis. Conclusion: In patients with AF, ISLL is a predictor of SSE, independent of conventional risk stratification schemes. Consequently, OAC should be strongly considered in this high-risk cohort. (Copyright © 2015 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu