Concomitant Left Atrial Appendage Closure During Left Ventricular Assist Device Surgery Can Reduce Ischaemic Cerebrovascular Accidents

Overview

Journal Interdiscip Cardiovasc Thorac Surg

Publisher Oxford University Press

Specialties Cardiology & Vascular Diseases
General Surgery
Pulmonary Medicine

Date 2023 Jul 8

PMID 37421402

Authors

Hidefumi Nishida

Valluvan Jeevanandam

Christopher Salerno

Atsushi Nemoto

Tae Song

David Onsager

Ann Nguyen

Jonathan Grinstein

Bow Chung

Nitasha Sarswat

Gene Kim

Sean Pinney

Takeyoshi Ota

Affiliations

Soon will be listed here.

Abstract

Objectives: It remains unknown if the left atrial appendage closure (LAAC) at the time of left ventricular assist device (LVAD) surgery can reduce ischaemic cerebrovascular accidents.

Methods: Consecutive 310 patients who underwent LVAD surgery with HeartMate II or 3 between January 2012 and November 2021 were included in this study. The cohort was divided into 2 groups: patients with LAAC (group A) and without LAAC (group B). We compared the clinical outcomes including the incidence of cerebrovascular accident between 2 groups.

Results: Ninety-eight patients were included in group A, and 212 patients in group B. There were no significant differences between 2 groups in age, preoperative CHADS2 score and history of atrial fibrillation. In-hospital mortality did not differ significantly between the 2 groups (group A: 7.1%, group B: 12.3%, P = 0.16). Thirty-seven patients (11.9%) experienced ischaemic cerebrovascular accident (5 patients in group A and 32 patients in group B). The cumulative incidence from ischaemic cerebrovascular accidents in group A (5.3% at 12 months and 5.3% at 36 months) was significantly lower than that in group B (8.2% at 12 months and 16.8% at 36 months; P = 0.017). In a multivariable competing risk analysis, LAAC was associated with reducing ischaemic cerebrovascular accidents (hazard ratio 0.38, 95% confidence interval 0.15-0.97, P = 0.043).

Conclusions: Concomitant LAAC in LVAD surgery can reduce ischaemic cerebrovascular accidents without increasing perioperative mortality and complications.

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