Prophylactic Left Atrial Appendage Exclusion in Cardiac Surgery Patients With Elevated CHA 2 DS 2 -VASc Score: Results of the Randomized ATLAS Trial.

Autor: Gerdisch MW; Franciscan Health Indianapolis, IN, USA., Garrett HE Jr; Cardiovascular Surgery Clinic, Memphis, TN, USA., Mumtaz MA; University of Pittsburgh Medical Center Central PA, Harrisburg, PA, USA., Grehan JF; Allina Health System, St. Paul, MN, USA., Castillo-Sang M; The Christ Hospital, Cincinnati, OH, USA., Miller JS; Emory University Hospital, Atlanta, GA, USA., Zorn GL 3rd; University of Kansas Medical Center, Kansas City, KS, USA., Gall SA Jr; CVA Heart Institute, Kingsport, TN, USA., Johnkoski JA; Aspirus Wausau Hospital, WI, USA., Ramlawi B; Lankenau Heart Institute, Philadelphia, PA, USA.
Jazyk: angličtina
Zdroj: Innovations (Philadelphia, Pa.) [Innovations (Phila)] 2022 Nov-Dec; Vol. 17 (6), pp. 463-470. Date of Electronic Publication: 2022 Nov 13.
DOI: 10.1177/15569845221123796
Abstrakt: Objective: Patients with elevated CHA 2 DS 2 -VASc scores are at high risk for atrial fibrillation (AF) and thromboembolic events (TE) after cardiac surgery. Left atrial appendage exclusion (LAAE) is a permanent, continuous approach to stroke prevention in AF, overcoming limitations of oral anticoagulation (OAC). We report ATLAS trial results focused on LAAE technical success and perioperative safety and TE rates with and without LAAE in cardiac surgery patients who developed postoperative AF (POAF).
Methods: ATLAS (NCT02701062) was a prospective, multicenter, feasibility trial. Patients age ≥18 years, undergoing structural heart procedure, with no preoperative AF, CHA 2 DS 2 -VASc ≥2, and HAS-BLED ≥2 were randomized 2:1 to LAAE or no LAAE. Patients who developed POAF and/or received LAAE were followed for 1 year. LAAE was evaluated with intraoperative transesophageal echocardiography.
Results: A total of 562 patients were randomized to LAAE ( n = 376) or no LAAE ( n = 186). Mean CHA 2 DS 2 -VASc (3.4 vs 3.4) and HAS-BLED (2.8 vs 2.9) scores were similar for LAAE and no LAAE groups. LAAE success (no flow nor residual stump >10 mm) was 99%. One LAAE-related serious adverse event (0.27%) occurred and was resolved without sequelae. There were 44.3% of patients who developed POAF. Through 1 year, 3.4% of LAAE patients and 5.6% of no LAAE patients had TE. OAC was used by 32.5% of POAF patients. Bleeding was higher with OAC than without (16.1% vs 5.4%, P = 0.008).
Conclusions: ATLAS demonstrated a high rate of successful LAAE with low LAAE-related serious adverse events in cardiac surgery patients. Study results should be considered in future trial design to further evaluate prophylactic LAAE for stroke prevention in cardiac surgery patients with elevated stroke risk.
Databáze: MEDLINE
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