Adding left atrial appendage closure to open heart surgery provides protection from ischemic brain injury six years after surgery independently of atrial fibrillation history:The LAACS randomized study
| Autor: | Anne S. Nørskov, Jesper Park-Hansen, Christian Lildal Carranza, Anders M. Greve, Johan S.R. Clausen, Akhmadjon Irmukhamedov, Egill Rostrup, Gina Al-Farra, Helena Dominguez, Christina Kruuse, Brian Nilsson, R.G.C. Riis, Susanne J.V. Holme |
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| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
Male
Denmark Postoperative Complications/diagnostic imaging 030204 cardiovascular system & hematology Cardiac Surgical Procedures/methods law.invention Brain Ischemia Brain ischemia 0302 clinical medicine Postoperative Complications Randomized controlled trial law Prospective Studies Atrial Appendage/surgery Stroke Hazard ratio Atrial fibrillation Left atrial appendage closure General Medicine Magnetic Resonance Imaging Cardiac surgery Treatment Outcome Anticoagulants/therapeutic use Cardiothoracic surgery Female Cardiology and Cardiovascular Medicine Research Article Pulmonary and Respiratory Medicine medicine.medical_specialty lcsh:Surgery Ischemia Disease-Free Survival lcsh:RD78.3-87.3 Prosthesis Implantation 03 medical and health sciences Brain Ischemia/diagnostic imaging medicine Humans Atrial Appendage Cardiac Surgical Procedures Aged business.industry Anticoagulants lcsh:RD1-811 medicine.disease Surgery Heart surgery lcsh:Anesthesiology business 030217 neurology & neurosurgery |
| Zdroj: | Park-Hansen, J, Holme, S J V, Irmukhamedov, A, Carranza, C L, Greve, A M, Al-Farra, G, Riis, R G C, Nilsson, B, Clausen, J S R, Nørskov, A S, Kruuse, C R, Rostrup, E & Dominguez, H 2018, ' Adding left atrial appendage closure to open heart surgery provides protection from ischemic brain injury six years after surgery independently of atrial fibrillation history : The LAACS randomized study ', Journal of Cardiothoracic Surgery, vol. 13, 53 . https://doi.org/10.1186/s13019-018-0740-7 Journal of Cardiothoracic Surgery Park-Hansen, J, Holme, S J V, Irmukhamedov, A, Carranza, C L, Greve, A M, Al-Farra, G, Riis, R G C, Nilsson, B, Clausen, J S R, Nørskov, A S, Kruuse, C R, Rostrup, E & Dominguez, H 2018, ' Adding left atrial appendage closure to open heart surgery provides protection from ischemic brain injury six years after surgery independently of atrial fibrillation history : the LAACS randomized study ', Journal of Cardiothoracic Surgery, vol. 13, no. 1, 53 . https://doi.org/10.1186/s13019-018-0740-7 Journal of Cardiothoracic Surgery, Vol 13, Iss 1, Pp 1-8 (2018) |
| ISSN: | 0237-8116 |
| DOI: | 10.1186/s13019-018-0740-7 |
| Popis: | Background Open heart surgery is associated with high occurrence of atrial fibrillation (AF), subsequently increasing the risk of post-operative ischemic stroke. Concomitant with open heart surgery, a cardiac ablation procedure is commonly performed in patients with known AF, often followed by left atrial appendage closure with surgery (LAACS). However, the protective effect of LAACS on the risk of cerebral ischemia following cardiac surgery remains controversial. We have studied whether LAACS in addition to open heart surgery protects against post-operative ischemic brain injury regardless of a previous AF diagnosis. Methods One hundred eighty-seven patients scheduled for open heart surgery were enrolled in a prospective, open-label clinical trial and randomized to concomitant LAACS vs. standard care. Randomization was stratified by usage of oral anticoagulation (OAC) planned to last at least 3 months after surgery. The primary endpoint was a composite of post-operative symptomatic ischemic stroke, transient ischemic attack or imaging findings of silent cerebral ischemic (SCI) lesions. Results During a mean follow-up of 3.7 years, 14 (16%) primary events occurred among patients receiving standard surgery vs. 5 (5%) in the group randomized to additional LAACS (hazard ratio 0.3; 95% CI: 0.1–0.8, p = 0.02). In per protocol analysis (n = 141), 14 (18%) primary events occurred in the control group vs. 4 (6%) in the LAACS group (hazard ratio 0.3; 95% CI: 0.1–1.0, p = 0.05). Conclusions In a real-world setting, LAACS in addition to elective open-heart surgery was associated with lower risk of post-operative ischemic brain injury. The protective effect was not conditional on AF/OAC status at baseline. Trial registration LAACS study, clinicaltrials.gov NCT02378116, March 4th 2015, retrospectively registered. Electronic supplementary material The online version of this article (10.1186/s13019-018-0740-7) contains supplementary material, which is available to authorized users. |
| Databáze: | OpenAIRE |
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